Presentation Authors: Ryan Mooney*, Dallas, TX, Kenneth Goldberg, Lewisville, TX, Claus Roehrborn, Daniel Wong, Dallas, TX
Introduction: Convective radiofrequency thermal therapy with the Rezum system is a relatively new treatment for benign prostatic hyperplasia (BPH) that has been shown to be durable through 3 years. We report an update of previously published data from a single center showing durability through 4 years.
Methods: A retrospective review of 255 patients from a single surgeon who underwent the Rezum procedure was performed, including 25 patients from the Rezum II study, from March 2014 to April 2018. The procedure was performed in office under local anesthesia. International prostate symptom scores (IPSS), Quality of life (QOL), maximum flow rates (Qmax), residual urine volumes (PVR), medication usage, and adverse events were monitored. Data was analyzed at baseline, 3 months, 6 months, 12 months, 24 months, 36 months, and 48 months after treatment. A scripted patient questionnaire was completed over the phone to assess patient satisfaction.
Results: Statistically significant improvement in Qmax (57.2%), IPSS (54.7%), and QOL (59.2%) appear to be durable through 48 months, with improvement >50% at most recent follow up. There was no statistically significant trend in PVR. We report similarly low reoperation rate when compared to the most recent data from the Rezum II study (3.1% vs 4.4%) however, higher rates of UTI (18.8% vs 3.7%) and urinary retention (15.7% vs 3.7%). High rate of UTI was related to use of a spanner (prostatic stent) postoperatively rather than a foley catheter. UTI rate improved significantly in the final 129 patients. Overall satisfaction with the procedure experience (93.9%) and the outcome (90.9%) were high with 97% of men interviewed recommending the procedure to a friend. Subgroup analysis revealed that despite small improvements in Qmax, IPSS, and QOL in groups with milder baseline symptoms, satisfaction remained at or above 90%. 80% of men were able to stop all medication. Men with prostates larger than 80 grams were more likely to go into urinary retention but showed similar improvement in IPSS (57.6%) with a dramatic overall improvement in Qmax (102.9%) although they also had high rates of retention (28.6%).
Conclusions: Rezum radiofrequency thermal therapy offers a minimally invasive treatment option for BPH. Our experience provides the largest published cohort of patients undergoing this procedure and shows durable improvements in Qmax, IPPS, and QOL through 4 years. Despite less significant improvements in objective measures, patients outside of the inclusion criteria of Rezum II (IPSS < 13, Qmax >15, prostate size >80g) have high satisfaction rates.