Comparative Post-Operative Outcomes of Rezūm™ Prostate Ablation in Patients with Large versus Small Glands - Beyond the Abstract

Benign prostatic hyperplasia (BPH) becomes increasingly common past the age of 40 and reaches up to 80% prevalence at 80 years of age.1 In many males, BPH leads to enlargement of the prostate gland causing bothersome lower urinary tract symptoms (LUTS). The prevalence of LUTS secondary to BPH has been shown at over 40% over 60 years of age. 2



Initial management of LUTS typically focuses on behavioral and medical approaches, however, when these are unsuccessful surgery is the gold standard. In the subset of patients with prostate glands >80cc, simple prostatectomy was historically considered the most efficient and durable option for treatment.3 However endoscopic management with bipolar transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) has also shown comparable outcomes.4,5

Rezūm™ prostate ablation is a new technology that delivers thermal energy via water vapor, which triggers cell necrosis when applied to prostatic tissue.6 The water vapor is delivered in nine-second injection treatments which are delivered transurethrally, to a maximum of 15 treatments. As a result, the procedure is short and does not need to be performed under anesthesia.

However, current literature only supports the use of Rezūm™ in prostate glands up to 80g. Therefore we found it essential to describe our experience with this patient subset undergoing Rezūm™.

Therefore, we performed a retrospective review of patients undergoing Rezūm™ at our institution since July of 2017. Baseline urinary symptoms and functional data were collected. Postoperative outcomes of men with gland sizes over 80cc versus those with gland sizes under 80cc were assessed at three-month follow-up.

Of 182 patients who underwent Rezūm™ in this timeframe, 47 out of 182 (25.8%) had glands >80cc, with 26 out of 47 (55.3%) of this subset reporting catheter-dependant urinary retention. The mean gland size amongst the large gland group was a notable 119cc.

Following Rezūm™, a clinically and statistically significant improvement was seen in large gland patient voiding parameters. The AUASS decreased from 22 to 13.4 (p=0.04) and peak flow rate was improved from 7.7ml/s to 12.7 ml/s (p=0.002). Finally, post-void residual decreased from 305cc to 149cc (p=0.05). In the catheter-dependant subset of men, the postoperative catheter-free rate of 83% in large glands was comparable to 88% in the small gland group. There was no significant difference in post-Rezūm™ complication rate based on prostate gland size.

Overall, we found Rezūm™ to be effective in treating both objective and subjective components of BPH at short-term follow up even in men with large glands >80cc. Outcomes were comparable to those demonstrated in men with smaller gland sizes. Further studies are warranted to obtain long term follow up, and to perform a side-by-side comparison of minimally invasive BPH treatments in large glands.

Written by: Raevti Bole, MD, Ajay Gopalakrishna, MD, Ruby Kuang, MD, Jamal Alamiri, MD, David Yang, MD, Sevann Helo, MD, Matthew Ziegelmann, MD, and Tobias Kohler, MD, Mayo Clinic, Urology, Rochester, Minnesota

References:

  1. Mazur, Daniel J., Brian T. Helfand, and Kevin T. McVary. "Influences of neuroregulatory factors on the development of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction in aging men." Urologic Clinics 39, no. 1 (2012): 77-88.
  2. Garraway, W. M., R. J. Lee, and G. N. Collins. "High prevalence of benign prostatic hypertrophy in the community." The Lancet 338, no. 8765 (1991): 469-471.
  3. Suer, Evren, Ilker Gokce, Onder Yaman, Kadri Anafarta, and Orhan Göğüş. "Open prostatectomy is still a valid option for large prostates: a high-volume, single-center experience." Urology 72, no. 1 (2008): 90-94.
  4. Jones, Patrick, Laith Alzweri, Bhavan Prasad Rai, Bhaskar K. Somani, Chris Bates, and Omar M. Aboumarzouk. "Holmium laser enucleation versus simple prostatectomy for treating large prostates: results of a systematic review and meta-analysis." Arab journal of urology 14, no. 1 (2016): 50-58.
  5. Gilling, Peter J., Liam C. Wilson, Colleen J. King, Andre M. Westenberg, Christopher M. Frampton, and Mark R. Fraundorfer. "Long‐term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years." BJU international 109, no. 3 (2012): 408-411.
  6. Westwood, Jennifer, Robert Geraghty, Patrick Jones, Bhavan P. Rai, and Bhaskar K. Somani. "Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia." Therapeutic Advances in Urology 10, no. 11 (2018): 327-333.
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