madman
Super Moderator
Abstract
Purpose of Review Rezum® is a novel convection-based thermal therapy for benign prostatic hyperplasia (BPH) induced lower urinary tract symptoms (LUTS). This review provides an overview of its safety, efficacy, cost, and potential role in the paradigm of BPH/LUTS therapies.
Recent Findings Data regarding Rezum® stems primarily from one large randomized controlled trial of 197 patients with 4 years of follow-up. The efficacy and safety of Rezum® are further supported by 4 additional studies including 1 prospective pilot study, 1 crossover study, and 2 retrospective studies. Durable improvements in IPSS (47–60%), QoL (38–52%), Qmax (45–72%), and PVR (11–38%) were seen without causing deterioration of sexual function.
Summary Rezum® offers a cost-effective and safe approach to treating BPH/LUTS and should be considered as a possible first-line therapy for patients with moderate to severe symptoms.
Introduction
Benign prostatic hyperplasia (BPH) refers to the formation of discrete nodules composed of stromal and epithelial cells within the transition zone of the prostate. When these nodules become sufficiently large, they can cause a mechanical bladder outlet obstruction (BOO) leading to lower urinary tract symptoms (LUTS). It is estimated that LUTS secondary to BPH impacts nearly 15 million individuals in the USA, with nearly 80% of men over the age of 70 affected [1]. Thus, BPH/LUTS continues to remain a significant cost burden on our healthcare system.
Traditionally, medical management has dominated first-line treatment for BPH. Alpha-adrenergic antagonists and 5- alpha-reductase inhibitors have documented efficacy in treating the functional and obstructive components leading to LUTS [2]. However, medication compliance can be an issue, often secondary to cost (especially over an extended course), adverse effects, and failure to meet therapeutic expectations [3]. Thus, many seek out definitive surgical therapy. Transurethral resection of the prostate (TURP) has remained the gold standard for the surgical management of BPH. However, the invasive nature of the procedure often necessitates the use of general anesthesia and can cause complications such as bleeding requiring transfusion, urethral stricture, urinary incontinence, erectile dysfunction, and retrograde ejaculation leading to a poorer quality of life (QoL) [4].
Consequently, numerous minimally invasive surgical therapies (MISTs) have blossomed for the treatment of BPH/ LUTS. These options are especially attractive because they generally have minimal anesthesia requirements and can be performed in an office-based setting. MISTs can be broadly divided into two categories based on their mechanism of action: mechanical expansion and thermal ablation. Prostatic urethral stents and prostatic urethral lift (UroLift®) are examples of MISTs that function by mechanical expansion, retracting tissue to expand the bladder outlet. MISTs that function via thermal ablation can be further subdivided into those that employ heat transfer via conduction, such as transurethral microwave therapy (TUMT) or transurethral needle ablation (TUNA), and those that utilize convective heat transfer, most notably Rezum®.
With conduction-based therapies (TUNA and TUMT), higher energy requirements are needed to generate large temperature gradients for adequate tissue ablation, resulting in longer treatment times [5]. With Rezum®, a significant amount of stored thermal energy is released as water vapor condenses back to a liquid following tissue contact. This causes immediate cell membrane denaturation and eventual coagulative necrosis which can be later resorbed, as opposed to thermal fixation often caused by conduction-based therapies which leads to a foreign-body-like reaction [6•, 7]. Also, because convection is achieved by both the random diffusion of particles (Brownian motion) and the bulk flow of said particles (advection), heat transfer can be achieved with no significant temperature gradient [8]. In addition, the collagenous pseudocapsule of the adenoma serves as a natural barrier to the flow of the convective current, resulting in focused treatment on the obstructive nodules. Rezum® thus offers a novel approach in the paradigm of BPH/LUTS treatment.
*Procedure Overview
*Efficacy
*Safety Profile
*Future Role of Rezum
Conclusion
Rezum® is a minimally invasive convection-based thermal therapy that allows for the focused treatment of BPH nodules within the transition zone of the prostate. It can be done so in the outpatient setting, with minimal sedation, and in a cost-effective manner. Both quantitative and qualitative improvements have been durable in patients with varied prostate characteristics. The procedure is safe, preserves sexual function, and boasts a low retreatment rate.
Purpose of Review Rezum® is a novel convection-based thermal therapy for benign prostatic hyperplasia (BPH) induced lower urinary tract symptoms (LUTS). This review provides an overview of its safety, efficacy, cost, and potential role in the paradigm of BPH/LUTS therapies.
Recent Findings Data regarding Rezum® stems primarily from one large randomized controlled trial of 197 patients with 4 years of follow-up. The efficacy and safety of Rezum® are further supported by 4 additional studies including 1 prospective pilot study, 1 crossover study, and 2 retrospective studies. Durable improvements in IPSS (47–60%), QoL (38–52%), Qmax (45–72%), and PVR (11–38%) were seen without causing deterioration of sexual function.
Summary Rezum® offers a cost-effective and safe approach to treating BPH/LUTS and should be considered as a possible first-line therapy for patients with moderate to severe symptoms.
Introduction
Benign prostatic hyperplasia (BPH) refers to the formation of discrete nodules composed of stromal and epithelial cells within the transition zone of the prostate. When these nodules become sufficiently large, they can cause a mechanical bladder outlet obstruction (BOO) leading to lower urinary tract symptoms (LUTS). It is estimated that LUTS secondary to BPH impacts nearly 15 million individuals in the USA, with nearly 80% of men over the age of 70 affected [1]. Thus, BPH/LUTS continues to remain a significant cost burden on our healthcare system.
Traditionally, medical management has dominated first-line treatment for BPH. Alpha-adrenergic antagonists and 5- alpha-reductase inhibitors have documented efficacy in treating the functional and obstructive components leading to LUTS [2]. However, medication compliance can be an issue, often secondary to cost (especially over an extended course), adverse effects, and failure to meet therapeutic expectations [3]. Thus, many seek out definitive surgical therapy. Transurethral resection of the prostate (TURP) has remained the gold standard for the surgical management of BPH. However, the invasive nature of the procedure often necessitates the use of general anesthesia and can cause complications such as bleeding requiring transfusion, urethral stricture, urinary incontinence, erectile dysfunction, and retrograde ejaculation leading to a poorer quality of life (QoL) [4].
Consequently, numerous minimally invasive surgical therapies (MISTs) have blossomed for the treatment of BPH/ LUTS. These options are especially attractive because they generally have minimal anesthesia requirements and can be performed in an office-based setting. MISTs can be broadly divided into two categories based on their mechanism of action: mechanical expansion and thermal ablation. Prostatic urethral stents and prostatic urethral lift (UroLift®) are examples of MISTs that function by mechanical expansion, retracting tissue to expand the bladder outlet. MISTs that function via thermal ablation can be further subdivided into those that employ heat transfer via conduction, such as transurethral microwave therapy (TUMT) or transurethral needle ablation (TUNA), and those that utilize convective heat transfer, most notably Rezum®.
With conduction-based therapies (TUNA and TUMT), higher energy requirements are needed to generate large temperature gradients for adequate tissue ablation, resulting in longer treatment times [5]. With Rezum®, a significant amount of stored thermal energy is released as water vapor condenses back to a liquid following tissue contact. This causes immediate cell membrane denaturation and eventual coagulative necrosis which can be later resorbed, as opposed to thermal fixation often caused by conduction-based therapies which leads to a foreign-body-like reaction [6•, 7]. Also, because convection is achieved by both the random diffusion of particles (Brownian motion) and the bulk flow of said particles (advection), heat transfer can be achieved with no significant temperature gradient [8]. In addition, the collagenous pseudocapsule of the adenoma serves as a natural barrier to the flow of the convective current, resulting in focused treatment on the obstructive nodules. Rezum® thus offers a novel approach in the paradigm of BPH/LUTS treatment.
*Procedure Overview
*Efficacy
*Safety Profile
*Future Role of Rezum
Conclusion
Rezum® is a minimally invasive convection-based thermal therapy that allows for the focused treatment of BPH nodules within the transition zone of the prostate. It can be done so in the outpatient setting, with minimal sedation, and in a cost-effective manner. Both quantitative and qualitative improvements have been durable in patients with varied prostate characteristics. The procedure is safe, preserves sexual function, and boasts a low retreatment rate.
