The Efficacy of Rezum Water Vapor Therapy Among Malaysian Men with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia
DOI:
https://doi.org/10.32896/tij.v4n1.9-20Abstract
Purpose: This study investigates the efficacy and safety of Rezǔm water vapor in the management of Malaysian men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).
Material and methods: A total of 60 men with symptoms of moderate to severe BPH were enrolled in pilot studies at Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia. All patients were treated with transurethral delivery of water vapor. International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow (Qmax), postvoid residual, and International Index of Erectile Function (IIEF-5) were evaluated at 1 week and 1, 3, and 6 months post-treatment. Safety was also assessed.
Results and discussion: The mean age of our study population was 64.57 ± 9.37 years old with mean prostate volume of 59.98 ± 22.06 cc. Our findings revealed statistically significant improvements throughout the 6 months of follow-up for IPSS score (17.45 ± 6.10 score to 7.53 ± 4.28), the QoL scores (3.52 ± 1.19 to 1.53 ± 0.70) and the urinary flow rate, Qmax (9.74 ± 3.39 mL/s to 17.40 ± 5.92 mL/s). There was no significant difference (p>0.05) was observed in sexual function (IIEF-5 scores) when compared to preoperatively. No adverse events (AEs) related to endoscopic instrumentations were observed. Two cases of urinary retention were classified as procedure-related AE.
Conclusion: The Rezǔm water vapor therapy is safe and provides effective relief of symptoms and it should be considered as one of the treatment options in patients with LUTs associated with BPH especially for patients who are keen to preserve sexual function as part of the added benefit in this treatment modality.
Keywords: Benign prostatic hyperplasia, lower urinary tract symptoms, water vapor therapy, minimally invasive
References
Auffenberg GB, Helfand BT, McVary KT. Established medical therapy for benign prostatic hyperplasia. Urol Clin North Am. 2009 Nov;36(4):443-59, v-vi. doi: 10.1016/j.ucl.2009.07.004. PMID: 19942044.
Bushman W. Etiology, epidemiology, and natural history of benign prostatic hyperplasia. Urol Clin North Am 2009; 36: 403–15.
Dixon C, Cedano ER, Pacik D, Vit V, Varga G, Wagrell L, Tornblom M, Mynderse L, Larson T. Efficacy and Safety of Rezūm System Water Vapor Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Urology. 2015 Nov;86(5):1042-7. doi: 10.1016/j.urology.2015.05.046. Epub 2015 Jul 26. PMID: 26216644.
Dixon C, Cedano ER, Pacik D, Vit V, Varga G, Wagrell L, Tornblom M, Mynderse L, Larson T. Efficacy and Safety of Rezūm System Water Vapor Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Urology. 2015 Nov;86(5):1042-7. doi: 10.1016/j.urology.2015.05.046. Epub 2015 Jul 26. PMID: 26216644.
Fusco F, Creta M, De Nunzio C, et al. Progressive bladder remodeling due to bladder outlet obstruction: a systematic review of morphological and molecular evidences in humans. BMC Urol 2018; 18: 15.
Fwu CW, Eggers PW, Kirkali Z, McVary KT, Burrows PK, Kusek JW. Change in sexual function in men with lower urinary tract symptoms/benign prostatic hyperplasia associated with long-term treatment with doxazosin, finasteride and combined therapy. J Urol. 2014 Jun;191(6):1828-34. doi: 10.1016/j.juro.2013.12.014. Epub 2013 Dec 14. PMID: 24342143.
GBD 2019 Benign Prostatic Hyperplasia Collaborators. The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Healthy Longev. 2022 Nov;3(11):e754-e776. doi: 10.1016/S2666-7568(22)00213-6. Epub 2022 Oct 20. PMID: 36273485; PMCID: PMC9640930.
Kiguradze T, Temps WH, Yarnold PR, Cashy J, Brannigan RE, Nardone B, Micali G, West DP, Belknap SM. Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride. PeerJ. 2017 Mar 9;5:e3020. doi: 10.7717/peerj.3020. PMID: 28289563; PMCID: PMC5346286.
McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, Levin RM, Rousseau M, Beahrs JR, Kaminetsky J, Cowan BE, Cantrill CH, Mynderse LA, Ulchaker JC, Larson TR, Dixon CM, Roehrborn CG. Minimally Invasive Prostate Convective Water Vapor Energy Ablation: A Multicenter, Randomized, Controlled Study for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. J Urol. 2016 May;195(5):1529-1538. doi: 10.1016/j.juro.2015.10.181. Epub 2015 Nov 22. PMID: 26614889.
McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 2011; 185: 1793–803.
Mynderse LA, Hanson D, Robb RA, Pacik D, Vit V, Varga G, Wagrell L, Tornblom M, Cedano ER, Woodrum DA, Dixon CM, Larson TR. Rezūm System Water Vapor Treatment for Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: Validation of Convective Thermal Energy Transfer and Characterization With Magnetic Resonance Imaging and 3-Dimensional Renderings. Urology. 2015 Jul;86(1):122-7. doi: 10.1016/j.urology.2015.03.021. Epub 2015 May 16. PMID: 25987496.
Ottaiano N, Shelton T, Sanekommu G, Benson CR. Surgical Complications in the Management of Benign Prostatic Hyperplasia Treatment. Curr Urol Rep. 2022 May;23(5):83-92. doi: 10.1007/s11934-022-01091-z. Epub 2022 Mar 9. PMID: 35262855.
Pietrzyk B, Olszanecka-Glinianowicz M, Owczarek A, Gabryelewicz T, Almgren-Rachtan A, Prajsner A, Chudek J. Depressive symptoms in patients diagnosed with benign prostatic hyperplasia. Int Urol Nephrol. 2015 Mar;47(3):431-40. doi: 10.1007/s11255-015-0920-5. Epub 2015 Feb 12. PMID: 25673555; PMCID: PMC4341023.
Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006 Nov;50(5):969-79; discussion 980. doi: 10.1016/j.eururo.2005.12.042. Epub 2006 Jan 30. PMID: 16469429.
Speakman MJ, Cheng X. Management of the complications of BPH/BOO. Indian J Urol. 2014 Apr;30(2):208-13. doi: 10.4103/0970-1591.127856. PMID: 24744522; PMCID: PMC3989825.
Welk B, McArthur E, Ordon M, Morrow SA, Hayward J, Dixon S. The risk of dementia with the use of 5 alpha reductase inhibitors. J Neurol Sci. 2017 Aug 15;379:109-111. doi: 10.1016/j.jns.2017.05.064. Epub 2017 May 31. PMID: 28716218.
Elterman D, Shepherd S, Saadat SH, Alshak MN, Bhojani N, Zorn KC, Rijo E, Misrai V, Lajkosz K, Chughtai B. Prostatic urethral lift (UroLift) versus convective water vapor ablation (Rezum) for minimally invasive treatment of BPH: a comparison of improvements and durability in 3-year clinical outcomes. Can J Urol. 2021 Oct;28(5):10824-10833. PMID: 34657655.
Chin CP, Garden EB, Ravivarapu KT, Shukla D, Omidele O, Levy M, Qian D, Araya JS, Valenzuela R, Reddy A, Marshall S, Motola J, Nobert C, Gupta M, Small AC, Kaplan SA, Palese MA. Medium-Term Real-World Outcomes of Minimally Invasive Surgical Therapies for Benign Prostatic Hyperplasia: Water Vapor Thermal Therapy (Rezum) vs Prostatic Urethral Lift (UroLift) in a High-Volume Urban Academic Center. J Endourol. 2022 Dec;36(12):1559-1566. doi: 10.1089/end.2022.0385. Epub 2022 Nov 9. PMID: 36039926.
Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, Lack N, Stief CG; Urology Section of the Bavarian Working Group for Quality Assurance. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008 Jul;180(1):246-9. doi: 10.1016/j.juro.2008.03.058. Epub 2008 May 21. PMID: 18499179.
Eure G, Rukstalis D, Roehrborn C. Prostatic Urethral Lift for Obstructive Median Lobes: Consistent Results Across Controlled Trial and Real-World Settings. J Endourol. 2023 Jan;37(1):50-59. doi: 10.1089/end.2022.0324. Epub 2022 Sep 9. PMID: 35876440; PMCID: PMC9810349.
Pushkaran A, Stainer V, Muir G, Shergill IS. Urolift - minimally invasive surgical BPH management. Expert Rev Med Devices. 2017 Mar;14(3):223-228. doi: 10.1080/17434440.2017.1296762. Epub 2017 Mar 8. PMID: 28270016.
Bardoli AD, Taylor WSJ, Mahmalji W. Can the UroLift prostatic implant device treat the symptoms of benign prostatic hypertrophy, avoid sexual dysfunction and reduce hospital TURP waiting times? A single centre, single surgeon experience and review of the literature. Aging Male. 2017 Sep;20(3):192-197. doi: 10.1080/13685538.2017.1336531. Epub 2017 Jun 13. PMID: 28609136.
Roehrborn CG, Barkin J, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, Cantwell AL, McVary KT, Te AE, Gholami SS, Moseley WG, Chin PT, Dowling WT, Freedman SJ, Incze PF, Coffield KS, Herron S, Rashid P, Rukstalis DB. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol. 2017 Jun;24(3):8802-8813. PMID: 28646935.
Dixon CM, Rijo Cedano E, Mynderse LA, Larson TR. Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezūm(®) system: evaluation of acute ablative capabilities in the human prostate. Res Rep Urol. 2015 Jan 30;7:13-8. doi: 10.2147/RRU.S74040. PMID: 25674555; PMCID: PMC4321608.
Elterman D, Shepherd S, Saadat SH, Alshak MN, Bhojani N, Zorn KC, Rijo E, Misrai V, Lajkosz K, Chughtai B. Prostatic urethral lift (UroLift) versus convective water vapor ablation (Rezum) for minimally invasive treatment of BPH: a comparison of improvements and durability in 3-year clinical outcomes. Can J Urol. 2021 Oct;28(5):10824-10833. PMID: 34657655.
Leigh Gilpin, David Zekan, Bryce Baugh,Apexa Patel, Stacie A Deslich, Samuel Deem, Ryan Fitzwater, Joshua Lohri, James Tierney, Nathan E Hale. Evaluating the Efficacy of Employing Local Anesthetic Prostatic Blocks During Rezum Procedure. Cureus. 2022 Sep; 14(9): e29598. doi: 10.7759/cureus.29598. PMID: 36321018
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