Water vapor therapy (Rezum®; Boston Scientific, Marlborough, MA, USA) for bladder outflow obstruction (BOO) due to benign prostatic enlargement (BPE) is a minimally invasive and innovative surgical technique. The aim of this study was to evaluate its mid-term results in a large multicentric cohort of Italian patients.
Patients with BPO and moderate to severe LUTS who underwent Rezum® (Boston Scientific) treatment from May 2019 to July 2021 were included in this study. Pre- and postoperative evaluation comprised full urological evaluation with urine culture, digital rectal examination, serum PSA, transrectal prostate ultrasound, uroflowmetry, post-void residual and IPSS, OAB-q SF, ICIQ-UI SF and IIEF-5, ejaculatory anterograde rate. Minimum follow-up was 12 months. Patients' subjective satisfaction was recorded with Patient Global Impression of Improvement (PGI-I) Scale together with any early or late reported complications, classified according to Clavien-Dindo Scale. Statistical analysis was conducted as appropriate.
Overall, 352 patients were eligible for the analysis. Procedures were routinely done on an outpatient basis. Mean operative was 12 minutes. The catheter was left in place for a median of 7 days. After treatment, Q<inf>max</inf>, IPSS and IPSS-QoL, OAB-q SF, ICIQ-UI SF and IIEF-5 from baseline to last control follow-up (median 16, IQR 13-20 months) were improved (P<0.05). The postoperative anterograde ejaculation rate was recorded in 74.1% vs. preoperative 43.8% (P<0.001). Early (≤30 days) postoperative complications occurred in 176 patients (50%), all Clavien-Dindo Grade ≤2. One patient experienced clot retention and hematuria requiring hospitalization and blood transfusion. No late AEs were recorded. Surgical retreatment rate was 2.5% (9/352), all cases occurred within the first year. Median PGI-I was 2 (1-2).
We confirmed the safety and efficacy of water vapor therapy for the treatment of symptomatic benign prostatic obstruction (BPO) on a large cohort of patients. Anterograde ejaculation was preserved in the majority of patients, with good subjective improvement. Further studies may rule out possible role of Rezum® (Boston Scientific) in new patients' setting.
Minerva urology and nephrology. 2023 Jan 19 [Epub ahead of print]
Luca Cindolo, Simone Morselli, Davide Campobasso, Enrico Conti, Giancarlo Sebastiani, Francesco Franzoso, Giuseppe Galluccio, Daniele Maruzzi, Francesco Visalli, Francesco Varvello, Marco Lucci Chiarissi, Lorenzo Viola, Francesco Sessa, Stefano Toso, Salvatore Micali, Giovanni Ferrari, Giampaolo Siena
Department of Urology, Villa Stuart Private Hospital, Rome, Italy., Department of Urology, Hesperia Hospital, Modena, Italy - ., Department of Urology, University Hospital of Parma, Parma, Italy., Department of Urology, Levante Ligure Hospital, La Spezia, Italy., Department of Urology, Hospital of Desio, Desio, Monza-Brianza, Italy., Department of Urology, Santa Maria Degli Angeli Hospital, Pordenone, Italy., Department of Urology, Michele e Pietro Ferrero Hospital, Alba, Cuneo, Italy., Department of Urology, San Luca Nuovo, Careggi Hospital, University of Florence, Florence, Italy., Department of Urology, Hesperia Hospital, Modena, Italy., Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.