Rezum Water Vapor Therapy Clinical Study. Patient Selection and Comfort.

Patient Selection and Comfort

Published in "How I Do It" in the Canadian Journal of Urology International, June 2019

Contributors

Christopher H. Cantrill, MD1
Kevin C. Zorn, MD2
Dean S. Elterman, MD3
Ricardo R. Gonzalez, MD4

The Rezūm system – a minimally invasive water vapor thermal therapy for obstructive benign prostatic hyperplasia


   

Patient Demographic

In the United States, benign prostatic hyperplasia is the most common diagnosis made by urologists for men 45 to 74 years of age.

Twenty percent of the population will reach 65 years of age or older by 2030, and those over 85 years will represent the fastest growing segment of our population. The prevalence of symptomatic BPH increases proportionally with the aging population.

Patient Selection

We have been able to offer this minimally invasive treatment option to men disenchanted with suboptimal LUTS improvements on medical therapy or facing the need for long-term medical therapy, and in selected patients as an alternative to more invasive surgical approaches.

Patients have reported satisfaction with significant early urinary symptom relief and preservation of their sexual functions that reflects the treatment outcomes in the published clinical studies supporting the development of this technology. High pressure voiding (obstruction, with no retention) and anatomical obstruction by the enlarged prostate can be considered for Rezūm Therapy or surgery, depending on the patient’s goals and treatment expectations. For example, in a sexually active man with obstruction by an intravesical median lobe, he may opt for treatment with Rezūm Therapy to improve LUTS and decrease the likelihood of ejaculatory dysfunction.

Patient Comfort

The Rezūm thermal therapy procedure is well suited to be performed in an office or ambulatory outpatient treatment setting with management of discomfort/pain and anxiety based on shared decision making between the patient and urologist.

Table 1: Pain management options for Rezūm Therapy procedures
Oral Medications Prostate Block Modified Prostate Block
(Dr. J.R. Beahrs)
IV Sedation
One Hour Prior To Procedure
  • Anti-anxiety – e.g. 1-2 mg alprazolam
  • Analgesia – e.g. 5-10 mg hydrocodone/acetaminophen or 5-10 mg oxycodone/ acetaminophen
  • Anti-inflammatory – e.g. ibuprofen
Supplies Needed
  • 22G needle
  • 20 cc lidocaine 1% (10 cc right, 10 cc left)
  • TRUS
Traditional Block
10 minutes prior to procedure:
  • Using a 22G needle, inject 3-4 cc of 1% lidocaine in the hyperechoic area between the prostate and the seminal vesicles (A) (e.g. “White Mountain”)
  • Inject 1-2 cc under the prostate from the vascular pedicle to the apex, between the prostate and the rectum (B)
Additional Modification
  • Inject 4-5 cc lateral to the seminal vesicle at the inferior hypogastric nerve plexus – e.g. the hyperechoic area between the prostate and the bladder neck, or the “Clouds Above the White Mountain” (C)
  • Repeat steps above bilaterally
To minimize risks associated with infection or bleeding:
  • Antibiotic 48 hours pre-procedure
  • Cease anticoagulation pre-procedure
Pain management – belladonna and opium 16.2 mg/30 mg suppository at the time of prostate block
  • IV sedation as per institution anesthesia protocol – e.g. IV propofol with monitored office anesthesia
Oral Medications
One Hour Prior To Procedure
  • Anti-anxiety – e.g. 1-2 mg alprazolam
  • Analgesia – e.g. 5-10 mg hydrocodone/acetaminophen or 5-10 mg oxycodone/ acetaminophen
  • Anti-inflammatory – e.g. ibuprofen
Prostate Block
Supplies Needed
  • 22G needle
  • 20 cc lidocaine 1% (10 cc right, 10 cc left)
  • TRUS
Traditional Block
10 minutes prior to procedure:
  • Using a 22G needle, inject 3-4 cc of 1% lidocaine in the hyperechoic area between the prostate and the seminal vesicles (A) (e.g. “White Mountain”)
  • Inject 1-2 cc under the prostate from the vascular pedicle to the apex, between the prostate and the rectum (B)
Modified Prostate Block
(Dr. J.R. Beahrs)
Additional Modification
  • Inject 4-5 cc lateral to the seminal vesicle at the inferior hypogastric nerve plexus – e.g. the hyperechoic area between the prostate and the bladder neck, or the “Clouds Above the White Mountain” (C)
  • Repeat steps above bilaterally
To minimize risks associated with infection or bleeding:
  • Antibiotic 48 hours pre-procedure
  • Cease anticoagulation pre-procedure
Pain management – belladonna and opium 16.2 mg/30 mg suppository at the time of prostate block
IV Sedation
  • IV sedation as per institution anesthesia protocol – e.g. IV propofol with monitored office anesthesia

Setting patient expectations and periprocedural pathways should help patient and surgeon satisfaction with this novel technique.

 
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