Procedural techniques and multicenter postmarket experience using minimally invasive convective radiofrequency thermal therapy with Rezūm system for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia

Abstract

ObjectiveThis report evaluates clinical experience with the Rezūm system after US Food and Drug Administration clearance in consecutive cases accrued by multiple community urologists for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Treatment techniques for transurethral convective radiofrequency water-vapor thermal therapy and outcomes with up to 12 months’ follow-up are presented.Materials and methodsA total of 131 patients with moderate–severe LUTS were included in a retrospective analysis of BPH procedures with the Rezūm system. Pre- and postprocedure assessments included International Prostate Symptom Score (IPSS), quality of life, peak urinary flow rate, voided volume, and postvoid residual urine volume. Urologists used their own discretion for patient selection, with variable prostate sizes, LUTS severity, urinary retention, or presence of an obstructing median lobe. Safety signals and surgical retreatment rates were monitored prospectively.ResultsMen aged 47–96 years with prostates 13–183 cm3 showed significant improvement in IPSS, quality of life, and postvoid residual volume durable through 12 months after thermal therapy. Patients with either moderate (IPSS 8–19) or severe (IPSS 20–35) symptoms achieved significantly improved scores. Postprocedure adverse events normally anticipated and related to endoscopic instrumentation were transient and mild–moderate in nature. No de novo erectile or ejaculatory dysfunction was reported.ConclusionThis study corroborates prior published pilot and randomized controlled trial results indicating significant relief of urinary symptoms and reproducibility of responses to thermal therapy. Convective radiofrequency thermal therapy with the Rezūm system warrants consideration as a first-line treatment for LUTS/BPH as an alternative to the use of pharmaceutical agents.

Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study

“…[15][16][17]19 The shared experiences with water vapor thermal therapy from community urology practices describe intraoperative techniques that may guide clinicians new to this efficient and versatile MIST and present outcomes after treating older patients and those with larger prostates. 8,21 One pitfall of proceeding to treatment without urodynamic study involves ignorance of bladder function, including degree of obstruction, underactive, or overactive bladder contractility-major contributors to the total LUTS complex.…”

“…Details of this technology and device have been previously reported. 3,8,9 The primary goal of the procedure is to create continuous, overlapping ablative lesions running parallel to the natural slope of the prostatic urethra, eliminating the tissue interfering with natural function. Confirmation of the contours of the prostate and planned disbursement of thermal lesions is determined at baseline cystoscopy.…”

Water vapor thermal therapy to alleviate catheter-dependent urinary retention secondary to benign prostatic hyperplasia

“…The intent of the procedure is to create continuous, overlapping ablative lesions running parallel to the natural slope of the prostatic urethra, eliminating tissue interfering with natural function. The technology, device, and procedure have been previously described in detail [1,3,9]. Briefly, contours of the prostate and planned disbursement of thermal lesions are determined at cystoscopy.…”

“…Water vapor thermal therapy with the Rezūm™ System utilizes convectively delivered thermal energy to target ablation of obstructive prostatic tissue. This minimally invasive surgical treatment now has a substantial history as an efficient, effective, and safe modality to treat clinically significant BPH [1][2][3][4]. The procedure is currently recommended for ablation of lateral and median lobes of the prostate [5].…”

Evaluation of ayurvedic therapy in management of Benign Prostatic Hyperplasia

“…The Benign Prostatic Hyperplasia (BPH) is one of the commonest problems amongst obstructive uropathies affecting a large population of the elderly community (Darson et al, 2017;Abrams and Grif iths, 1979). Although this disorder is almost universal among aging men, its etiopathogenesis is poorly understood.…”