Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
WHB Siu(1), KL Lo(1), A Mok(1), H Kwok(1), I Wu(1), PKF Chiu(1), JYC Teoh(1), SCH Yee(1), CK Chan(1), HC Chan(1), HM Tam(1), KM Li(1), YS Chan(1), SKK Yuen(1), HF Wong(1), FCH Wong(1), CF Ng(1)
Affiliation :
(1)S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
Introduction :
Benign prostatic hyperplasia (BPH) is a prevalent histological condition.
BPH can be complicated by acute urinary retention (AUR). From the Olmsted County Study, the overall risk of AUR has been estimated as 23% for an average 60-year-old man if he survives another 20 years. AUR secondary to BPH is a major burden to healthcare system. The gold standard treatment has been Transurethral resection of prostate (TURP). In the COVID era, Hong Kong’s service for operations requiring general/spinal anesthesia had been severely impacted, especially for benign conditions. The condition has been further exacerbated by the shortage of
anesthesia and nursing manpower, resulting in a median waiting time of NTEC of 11 months for TURP in refractory retention with catheter in situ in July 2023. Transurethral water vapour therapy (REZUM) with pure local anesthesia emerged as a promising option for these men in this special era. It is particularly suitable for older patients at high risk of general anesthesia, and also for younger patients who wish to preserve sexual function and continence.
Objectives :
To evaluate the safety and efficacy of REZUM for benign prostatic hyperplasia
(BPH) at 1 year follow up.
Methodology :
Between June 2020 and July 2022, 105 men with BPH underwent Transurethral Water Vapour Thermal Therapy (REZUM) in NTEC. 45/105(42.9%) of them had refractory retention on indwelling catheter or clean intermittent catheterization, 11/105 (10.5%) had history of acute retention but weaned off catheter before operation, 49/105 (46.7%) had lower urinary tract symptoms (LUTS) secondary to BPH.
Result & Outcome :
At 1 year follow up, 95.6% of the patients with urinary catheter in-situ were able to wean off the catheter (TWOC) after Rezum. All patients were discharged same day. There were no Clavien Dindo grade 3 or above complications. The medication discontinuation rate was 65.2%, clinic discharge rate was 22.9%. Median prostate size, maximum flow rate (Qmax), residual urine (RU) and International Prostate symptoms Score (IPSS) showed 22.7%, 73.4%, 39.4% and 70.7% improvement respectively.
2 patients who failed TWOC both had small prostate and poor premorbid functional status, 1 of them had preoperative diagnosis of detrusor underactivity.
REZUM provided significant and durable improvement in symptoms and uroflowmetry parameters. The catheter-free rate for those with refractory retention was also promising. REZUM has become a great solution to urologists and anesthesiologists for growing demand for BPH surgery, and more importantly, to patients with catheter in-situ who can avoid the prolonged wait for surgery.
