Comparison of water vapor thermal therapy and prostate artery embolization for fragile patients with indwelling urinary catheters: Preliminary results from a multi-institutional study.

To report our preliminary experience with water vapor thermal therapy with the Rezūm™ System and Prostate Artery Embolization (PAE) for treatment of medically refractory, complete urinary retention to achieve successful cessation of catheter dependency in frail-patients.

A multi-institutional study was conducted including all patients who underwent Rezūm™ procedure and PAE between October 2017 and June 2020. The included population focused on frail-patients unsuitable for conventional surgery with complete urinary retention. Rezūm™ patients were identified and matched (1:1) with patients who underwent PAE. The matching criteria were age, Charlson score, prostate volume and duration of follow-up. The primary outcome was catheter-free survival, defined as spontaneous voiding and release from catheter dependence.

Eleven patients from the Rezūm™ group were matched to 11 embolized patients. PAE and Rezūm™ patients were comparable in age (median: 77 vs. 75 years), Charlson score (median: 6 vs. 6) and prostate volume (74 vs. 60 cc). Procedures were significantly longer in the PAE group compared to the Rezūm™ procedures (median: 148 vs. 8min, P<0.001). After a median follow-up of 12 months, spontaneous voiding was conserved in all cases (100%) after the Rezūm™ procedure and in 5 cases (45.4%) after PAE (P=0.01). In catheter-free patients, the rate of benign prostatic hyperplasia medication use after procedure was 40% for PAE and 18.2% for Rezūm™ patients (P=0.54).

Our preliminary experience for treatment of complete urinary retention in frail-patients shows the feasibility of PAE and Rezūm™ to restore spontaneous urination without being associated with the occurrence of major complications. Early data suggests that Rezūm™ may provide superior results in terms of cessation of catheter dependence. Future studies are needed to definitively assess which treatment would be best suited for each patient.

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Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2021 Jun 17 [Epub ahead of print]

M Baboudjian, C Alegorides, M Fourmarier, A Atamian, B Gondran-Tellier, M Andre, F Arroua, R Boissier, C Eghazarian, V Vidal, A Chevrot, S Droupy, E Lechevallier

Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France; Department of Urology, Hospital of Aix en Provence, Aix en Provence, France. Electronic address: ., Department of Urology, Hospital of Aix en Provence, Aix en Provence, France., Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France., Department of Radiology and Medical imaging, La Timone Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France; European Center for Medical Imaging Research CERIMED/LIIE, Marseille, France., Department of Urology, Hospital Universitaire Carémeau de Nimes, Nimes, France.

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