Transurethral water vapor ablation of the prostate with the Rezūm system: Urodynamic findings

Abstract

Aims The efficacy of the transurethral convective interstitial radiofrequency water vapor thermal ablation of the prostate with the Rezūm system for the treatment of male lower urinary tract symptom due to benign prostatic hyperplasia is well proven. The improvement of urodynamic parameters obtained from a simple uroflowmetry cannot measure the effect of water vapor injection on the bladder outlet obstruction. Methods This monocentric retrospective pilot study analyzes the data of pressure‐flow studies performed before and after 17 Rezūm procedures to answer the question whether thus obtained ablation of prostate tissue has a disobstructive effect on the bladder outlet. Results All the functional outcomes were consistently improved after the procedure, with a median flowrate increase of 5.1 ml/s (p = 0.0022) and a median postvoid residual urine (PVR) reduction of 100 ml (p = 0.0042). The prostate volume was reduced by 40% (p < 0.0001) and the median Bladder Outlet Obstruction Index (BOOI) reduction was 53.8 (p < 0.0001). Conclusions These data show that the possibility to significantly reduce the obstruction grade with even a single Rezūm procedure is concrete and seems to be independent from the degree of the obstruction grade.

Real-World experience of water vapour therapy (Rezum) in patients with benign prostatic enlargement: a retrospective single-center study

“…Whether the rate of postoperative deobstruction would have been higher if all patients had undergone repeat urodynamic testing remains speculative. Our study con rms the ndings of a previous study that reported a BOOI reduction of 53.8 cmH 2 O (12).…”

“…In 2021, a randomized controlled clinical trial reported signi cant improvements in patient-related symptom relief, quality of life, and uro owmetry measurements over a 5-year follow-up period (5). Rezum has also been shown to be safe and effective in multiple retrospective studies (6)(7)(8)(9)(10)(11), but data on its effect on bladder outlet obstruction (BOO) are rare (12).…”

Can we predict and manage persistent storage and voiding LUTS following bladder outflow resistance reduction surgery in men? ICI‐RS 2023

“…39 The BOOI was reduced by 53 in a small study of patients treated with WVTT, and a study of urodynamic outcomes following robotic water jet ablation reported comparable reductions in pdetQmax to TURP (35cmH 2 O). 40,41 However, studies on urodynamic outcomes are limited to small, retrospective series, with heterogenous outcome measures, and so prospective comparative studies with urodynamic outcomes are required. Importantly, differences in outcome may also occur with the same surgical treatment due to surgical variability.…”

“…A study of 20 patients treated with PUL reported only modest relief of obstruction based on urodynamic parameters (reduction in urethral resistance factor of 15cmH 2 O) 39 . The BOOI was reduced by 53 in a small study of patients treated with WVTT, and a study of urodynamic outcomes following robotic water jet ablation reported comparable reductions in pdetQmax to TURP (35cmH 2 O) 40,41 . However, studies on urodynamic outcomes are limited to small, retrospective series, with heterogenous outcome measures, and so prospective comparative studies with urodynamic outcomes are required.…”