Presented by: Clara Cerrato MD
University Hospital Southampton NHS Trust, Southampton, United Kingdom

Introduction

We sought to determine predictors of post-operative outcomes and adverse events for patients who underwent Rezum treatment for BPH. 

Materials

We performed a multi-institutional retrospective review of patients who underwent Rezum procedure for symptomatic BPH between April 2019 and November 2022. Patients’ demographics, pre- and peri-operative data, prostate volume (PV) and total international prostate symptoms score (IPSS) were evaluated.. Primary outcomes were predictors for development of post-operative adverse events (AEs) at one month follow up (persistent irritative symptoms [PIS], de novo UTI, retention or bleeding, or surgical retreatment by one year).Patients with pre-operative urinary retention requiring catheterization were excluded. 

Results

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798 patients were included in the analysis, with 177 (22.2%) having AEs, the majority of which was retention (12.3%)(Table 1). 42 (4.3%) patients had persistent irritative symptoms at one month postop (PIS), and 22 (2.8%) patients required retreatment within one year. AE group showed older age, larger prostate volumes, more treatments and longer post-operative catheterization (all significant). On multivariate analysis (MVA), decreasing pre-operative IPSS was associated with a higher overall probability of AEs (B -0.005, p=0.044) and PIS(B -0.003, p=0.020).Absence of median lobe (B -0.040, p=0.039) and decreasing PV/treatment ratio (more treatments per unit volume) (B -0.004, p=0.033) were independently associated with higher probability of de-novo UTI, whereas presence of median lobe (B 0.070, p=0.004), decreasing pre-op IPSS (B -0.004, p=0.035) and decreasing PV/treatment ratio (B -0.005, p=0.046) were associated with higher risk of development de-novo urinary retention. Higher preop IPSS scores were associated with higher postop IPSS scores at 1, 3-6 and 12 months (p>0.001).

Conclusion

Our results confirm that Rezum is a safe and effective option for patients undergoing treatment for BPH with low AEs and retreatment rates. Pre-op IPSS, PV/treatment ratio, and presence of median lobe may help predict the development of postoperative AEs, but our study is limited by overall low numbers of AEs. Further analyses and longer follow-up are needed.

Funding

None.

Co-Authors

Mimi Vi Nguyen, MD
University of California San Diego

Vi Nguyen, MD
University of California San Diego

Savio Domenico Pandolfo, MD
University of Naples Federico II

Michelle Leach, MD
University of California San Diego

Raffaele Balsamo, MD, PhD
Monaldi Hospital

Francesco Uricchio, MD
Monaldi Hospital

Juan A. Fulla, MD
Clinica Las Condes

Dean Elterman, MD
University of Toronto

Kevin C. Zorn, MD
Centre Hospitalier de l'Universite de Montreal

Naeem Bhojani, MD
Centre Hospitalier de l'Universite de Montreal

Bilal Chughtai, MD
Weill Cornell Medicine

Seth K. Bechis, MD
University of California San Diego