Research frontier Prostatic hyperplasia patients for several years of "male" words can be solved in 10 minutes? The results of a multicenter study of minimally invasive therapy Rezum were announced

The incidence of lower urinary tract symptoms (LUTS) caused by benign prostatic obstruction (BPO) increases with age, plaguing many middle-aged and older men
.
As common treatment options for benign prostatic hyperplasia (BPH), drugs and surgery still have some shortcomings, such as difficulty in preserving patients' sexual function, high incidence of surgery-related complications, and poor drug compliance
.

Recently, an article published by Prostate Cancer Prostatic Dis announced the urinary and sexual function outcomes of BPH patients treated with minimally invasive therapy Rezum.

The Rezum system is one of the latest minimally invasive surgical treatments for BPH, but data
on urinary and sexual outcomes and complications are lacking.
This review reviewed data from multicentre cases in Italy between June 2019 and April 2021 to assess the urinary and sexual outcomes of Rezum
.

The study included all patients
treated with moderate to severe LUTS with BPO and moderate to severe LUTS who were treated with Rezum in seven Italian medical centers.
Exclusion criteria were age< 18 years, history of previous BPO intervention, international prostate symptom score (IPSS) mild, maximum urine flow rate (Qmax) > 15 mL/s, prostate volume < 30 and > 120 cc, residual urine volume (PVR) > 250 ml
.
The investigators defined ideal voiding function as an IPSS score of < score of 7 or ≥50% improvement (from baseline), a ≥50% improvement in peak flow rate and/or >15 mL/s, an improvement of ≥1 point in the quality of life questionnaire score, and the absence of major complications
such as acute urinary retention (AUR), blood transfusion, or urinary incontinence during the perioperative period.
Ideal sexual function is defined as maintaining anterograde ejaculation or no change in ejaculatory function after surgery (most recent follow-up) and increasing or stabilizing or decreasing the International Erectile Function Index (IIEF-5) score ≤ grade
1.

A total of 262 patients were included with a median follow-up of 11 (IQR 5-15) months
.
The median surgical time from instrument insertion through the urethra to patient catheter placement was 11 (IQR 9-15) minutes, and most patients (62.
5%) were discharged within hours of surgery without serious complications
with Clavien-Dindo complication grade III or IV.
Early complications occurred in 39.
3% of patients, of which 4 (1.
5%) developed clot retention and 1 (0.
39%) required blood
transfusion.
Urge urinary incontinence occurred in 6 (2.
2%) patients, and 4 (1.
5%) patients had reoperation
after treatment failure.

Table 1 Early and late complications

52.
9% and 87.
8% of patients, respectively, achieved ideal voiding
and sexual outcomes.
Thirty-eight patients with preoperative indwelling urinary catheters did not require indwelling catheterization after Rezum surgery, 70% of patients had IPSS scores < 7 points or ≥50% improvement from baseline, 70.
2% improved peak flow rate ≥ 50% and/or > 15 mL/s, and 92.
7% improved their quality of life questionnaire scores by ≥1 point
.
The anterograde ejaculation rate of Rezum patients was 56.
5% before surgery and increased to 78.
2% postoperatively, an increase of 21.
7%.

Ejaculation function was preserved
in 96.
6% of patients.
By the end of follow-up, there were no newly diagnosed cases
of erectile dysfunction.

Table 2 Changes in functional parameters of Rezum after surgery

In summary, Rezum is a safe and well-tolerated minimally invasive surgical modality, which is beneficial to improve urinary function and preserve sexual function
in BPH patients.

References:

Campobasso D, Siena G, Chiodini P, et al.
Composite urinary and sexual outcomes after Rezum: an analysis of predictive factors from an Italian multi-centric study.
Prostate Cancer Prostatic Dis.
2022 Aug 30.

Editor: Mumu Wang

Review: LR

Execution: Wang Mumu