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Minore A, Morselli S, Franzoso F, Maruzzi D, Varvello F, Toso S, Ferrari G, Siena G, Conti E, Papalia R, Uricchio F, Balsamo R, Scarpa RM, Cindolo L. Is water vapor thermal therapy safe and feasible in elderly and frail men? The Italian experience. World J Urol 2024; 42:60. [PMID: 38280069 DOI: 10.1007/s00345-023-04762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/12/2023] [Indexed: 01/29/2024] Open
Abstract
PURPOSE In recent years, water vapor thermal therapy (WVTT) has spread as minimally invasive technique in lower urinary tract symptoms due to benign prostatic hyperplasia treatment. Even if its safety and feasibility have been largely proved in young men, nobody has proved the same feasibility and safety in the elderly (men older than 75 years old). Our aim is to compare WVTT safety outcomes in men older than 75 with younger men. METHODS We prospectively collected data on men who underwent water vapor thermal therapy from 2019. We compared data on operative time, number of injections, intra-operative and post-operative complications, reinterventions rate. RESULTS We enrolled 426 patients; among these, 60 were older than 75 years old, 366 were younger. Our cohorts of patients had similar results in terms of intra-operative and post-operative complications. Operative time accounts about 11 min for both groups (p = 0.535), total number of injections was seven for young men and eight for elderly (p = 0.314). We found no intra-operative complications in elderly men group and only one in the younger group (p = 0.678), while five younger men underwent clot retention, and two elderly men experienced this complication (p = 0.239). Only one transfusion occurred in the elderly group. No differences between groups occurred in terms of length of stay, post-operative urinary retention and reintervention rate, while catheterization time was longer in the elderly men. CONCLUSION WVTT is a safe procedure in elderly patients with comparable intra-operative and post-operative complication rate in comparison with younger patients.
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Affiliation(s)
- Antonio Minore
- Department of Urology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Simone Morselli
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy
| | | | - Daniele Maruzzi
- Department of Urology, S. Maria Degli Angeli Hospital, Pordenone, Italy
| | - Francesco Varvello
- Department of Urology, Michele e Pietro Ferrero Hospital, Alba-Bra, Italy
| | - Stefano Toso
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy
| | - Giampaolo Siena
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence, Italy
| | - Enrico Conti
- Department of Urology, Levante Ligure Hospital, La Spezia, Italy
| | - Rocco Papalia
- Department of Urology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Uricchio
- Department of Urology, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Raffaele Balsamo
- Department of Urology, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | | | - Luca Cindolo
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy.
- Department of Urology, "Villa Stuart" Private Hospital, Rome, Italy.
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Schwartzmann I, García Barreras S, D'Anna M, Parejo V, Torneo Ruiz I, Tagalos Muñoz AC, Bravo-Balado A, Diana P, Peri L, Domínguez Esteban M, Fernández Guzmán E. Water vapor thermal therapy: Technical variations among spanish hospitals and efficacy at 2-year follow-up. Actas Urol Esp 2023; 47:668-674. [PMID: 37423384 DOI: 10.1016/j.acuroe.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 07/11/2023]
Abstract
AIM The aim of this work is to evaluate the initial experience with water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in Spanish university hospitals, as well as to describe the differences in technique and follow-up between centers. MATERIALS AND METHODS This retrospective observational multicenter study collected baseline characteristics, surgical, postoperative and follow-up data at 1, 3, 6, 12 and 24 months, including validated questionnaires, flowmetric variations, complications, and the need for pharmacological or surgical treatment following the procedure. Possible triggers for postoperative acute urinary retention (AUR) were also analyzed. RESULTS A total of 105 patients were included. No differences were observed between the groups with and without AUR with respect to catheterization time (5 and 4.3 days respectively, P=.178), or prostate volume (47.9g and 41.4g respectively, P=.147). The mean improvement at 3, 6, 12 and 24 months in terms of peak flow was 5.3, 5.2, 4.2 and 3.8ml/s, respectively. As for ejaculation, an improvement was observed after 3 months of follow-up and was maintained over time. CONCLUSIONS Minimally invasive treatment for BPH with WVTT shows good functional outcomes at 24 months follow-up, without significant impairment of sexual function and a low incidence of complications. There are minor inter-hospital variations, mainly in the immediate postoperative period.
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Affiliation(s)
- I Schwartzmann
- Servicio de Urología de la Fundació Puigvert, Barcelona, Spain.
| | | | - M D'Anna
- Servicio de Urología, Hospital Clínic, Barcelona, Spain
| | - V Parejo
- Servicio de Urología, Hospital de Girona Dr. Josep Trueta, Gerona, Spain
| | - I Torneo Ruiz
- Servicio de Urología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - A Bravo-Balado
- Servicio de Urología de la Fundació Puigvert, Barcelona, Spain
| | - P Diana
- Servicio de Urología de la Fundació Puigvert, Barcelona, Spain
| | - L Peri
- Servicio de Urología, Hospital Clínic, Barcelona, Spain
| | - M Domínguez Esteban
- Servicio de Urología, Hospital Universitario Marqués de Valdecillas, Santander, Spain
| | - E Fernández Guzmán
- Servicio de Urología, Hospital Universitario Marqués de Valdecillas, Santander, Spain
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Woo H, Levin R, Cantrill C, Zhou S, Neff D, Sutton M, Bailen J, Darson M, Horgan J, Zantek P, Marty-Roix R. Prospective Trial of Water Vapor Thermal Therapy for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia in Subjects with a Large Prostate: 6- and 12-month Outcomes. EUR UROL SUPPL 2023; 58:64-72. [PMID: 38152482 PMCID: PMC10751540 DOI: 10.1016/j.euros.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/29/2023] Open
Abstract
Background Current guidelines recommend Rezūm water vapor thermal therapy for the treatment of benign prostatic hyperplasia (BPH) for prostate glands ranging in volume from 30 to 80 cm3. Few prospective studies have specifically evaluated the use of Rezūm for larger prostates. Objective To evaluate the safety and efficacy of water vapor thermal therapy in patients with a prostate gland >80 cm3 and ≤150 cm3. Design setting and participants In this prospective, single-arm study at seven centers in the USA, subjects were males aged >50 yr with symptomatic BPH and prostate volume of >80 cm3 and ≤150 cm3. Intervention Rezūm was used to deliver sterile water vapor via a transurethral approach to ablate targeted areas of prostate tissue. Outcome measurements and statistical analysis The primary efficacy outcome was response to therapy, defined on a per-patient basis as a ≥30% improvement in International Prostate Symptom Score (IPSS) from baseline to 6 mo. The primary safety outcome was a composite of serious device-related safety events. Secondary outcomes included catheterization for device-related retention. IPSS outcomes over time were analyzed via generalized estimating equations. Results and limitations Among 47 eligible patients, prostate volume ranged from 80.8 to 148.1 cm3. All patients completed 6-mo follow-up, and 40/47completed 12-mo follow-up. At 6 mo, 83% were treatment responders according to the primary efficacy endpoint. The mean IPSS improvement at 6 mo was 11.9 ± 7.5 points, reflecting significant improvement. The primary safety outcome was met, with no occurrence of device-related composite safety events. The study is limited by the nonrandomized design and early termination, unrelated to safety or effectiveness. Conclusions Our results are consistent with previous findings for prostate glands of up to 80 cm3, and indicate the safety and efficacy of Rezūm for BPH in patients with a larger prostate. Patient summary Rezūm therapy, in which water vapor is used to treat targeted areas of the prostate, is currently recommended for patients with benign enlargement of the prostate and a prostate size of up to 80 cm3. We found that this treatment was also effective and safe in patients with a larger prostate of 80-150 cm3.
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Affiliation(s)
- Henry Woo
- College of Health and Medicine, Australian National University and SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, Australia
| | | | | | - Shaw Zhou
- Pinellas Urology, South Pasadena, FL, USA
| | - Donald Neff
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | | | - Paul Zantek
- Boston Scientific Corporation, Marlborough, MA, USA
| | | | - Rezūm Clinical Trials Group
- College of Health and Medicine, Australian National University and SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, Australia
- Chesapeake Urology, Baltimore, MD, USA
- Urology of San Antonio, San Antonio, TX, USA
- Pinellas Urology, South Pasadena, FL, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- Houston Metro Urology, Houston, TX, USA
- First Urology, Louisville, KY, USA
- Arizona Urology Specialists, Scottsdale, AZ, USA
- Adult & Pediatric Urology, Omaha, NE, USA
- Boston Scientific Corporation, Marlborough, MA, USA
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4
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Yang J, Wu W, Amier Y, Li X, Wan W, Liu C, Zhang Y, Yu X. Efficacy and safety of Water Vapor Thermal Therapy in the treatment of benign prostate hyperplasia: a systematic review and single-arm Meta-analysis. BMC Urol 2023; 23:72. [PMID: 37118692 PMCID: PMC10147364 DOI: 10.1186/s12894-023-01237-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/05/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a common chronic condition among men aged 50 or older, causing voiding and obstructive lower urinary tract symptoms. Water vapor thermal therapy (WVTT) using the Rezūm® system is a new minimally invasive surgical technique that is increasingly reported as a treatment for BPH. METHODS The protocol was submitted to the PROSPERO registry. We searched PubMed, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov up to July 29, 2022. Quality assessment was carried out by a 20-item checklist form prepared by the Institute of Health Economics (IHE). Double arcsine transformation was performed to stabilize the variance of the original ratio. When I2 > 50%, the random effect model was used to calculate the pooled parameters. Otherwise, the fixed effect model was used. 95% confidence intervals (CIs) were calculated. A leave-one-out sensitivity analysis was performed to evaluate the impact of each study on the pooled outcomes, and finally, Egger's test was used to assess publication bias. RESULTS A total of seven single-arm observational studies and one random controlled trial, including 1015 patients, were included. One year after WVTT, the International Prostate Symptom Score decreased by 11.37 (95% CI: -12.53, -10.21), the IPSS Quality of Life scale decreased by 2.59 (95% CI: -2.92, -2.26), the maximum urine flow rate increased by 5.26 ml/s (95% CI: 4.53, 5.99), and the postvoid residual decreased by 13.18 ml (95% CI: -24.32, -2.03). The most common complication was dysuria, with a pooled incidence of 21% (95% CI: 14%, 29%), and the second most common complication was hematuria, with a pooled incidence of 14% (95% CI: 10%, 18%). The pooled incidence of retreatment was 3% (95% CI: 2%, 5%). CONCLUSIONS WVTT is an attractive alternative to medication or more invasive surgical procedures and can serve as first-line therapy for men with BPH.
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Affiliation(s)
- Junyi Yang
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Weisong Wu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yirixiatijiang Amier
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xianmiao Li
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wenlong Wan
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chang Liu
- Department of Geriatrics, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yucong Zhang
- Department of Geriatrics, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Xiao Yu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Niu X, Liu B. Six novel minimally invasive therapies for benign prostatic hyperplasia. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:162-168. [PMID: 37283100 DOI: 10.3724/zdxbyxb-2022-0593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms in men. When drug treatment is ineffective or conventional surgery is not suitable, novel minimally invasive therapies can be considered. These include prostatic urethral lift, prostatic artery embolisation, water vapor thermal therapy, Aquablation-image guided robotic waterjet ablation, temporary implantable nitinol device and prostatic stents. These novel therapies can be performed in outpatient setting under local anesthesia, with shorter operative and recovery times, and better protection of ejaculatory function and erectile function. General conditions of the patient and advantages and disadvantages of the each of these therapies should be fully considered to make individualized plans.
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Affiliation(s)
- Xinyang Niu
- Department of Urology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
| | - Ben Liu
- Department of Urology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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Tadrist A, Baboudjian M, Bah MB, Alegorides C, Bottet F, Arroua F, Eghazarian C, Fourmarier M. Water vapor thermal therapy for indwelling urinary catheter removal in frail patients. Int Urol Nephrol 2023; 55:249-253. [PMID: 36342555 DOI: 10.1007/s11255-022-03408-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To report the efficacy and safety of water vapor thermal therapy to achieve catheter removal in frail patients with refractory acute urinary retention. METHODS Data from consecutive frail patients with indwelling urinary catheter undergoing the Rezūm™ therapy (Boston Scientific Corporation, Marlborough, MA) at a single center between October 2017 and June 2021 were prospectively collected. The included patients were deemed unfit or at high risk of complications for conventional benign prostatic hyperplasia (BPH) surgery. Prostate volumes up to 120 mL were considered eligible. The primary endpoint was successful cessation of catheter dependency, assessed postoperatively and up to 1 year of follow-up. RESULTS A total of 24 men met our inclusion criteria. The median age, Charlson comorbidity index, and duration of preoperative catheterization were 77 years (IQR 67-86), 6 (IQR 3-7), and 113 days (IQR 87-159), respectively. Two cases (8.3%) of postoperative complications were recorded (Clavien II and Clavien IIIa). After a median postoperative catheterization time of 21 days (IQR 11-32), all patients regained spontaneous voiding. During follow-up, two patients died and a total of 22 patients completed the 1 year follow-up. All patients maintained spontaneous voiding without recurrence of urinary retention. No surgical retreatment was performed. In terms of pharmacological management, 22/24 patients (91.7%) had a BPH medication pre-Rezūm™; this decreased to 8/22 patients (36.3%) post-Rezūm™ (p < 0.001). CONCLUSIONS In this single-institution, prospective, and observational study, water vapor thermal therapy was found to be effective and safe in restoring successful spontaneous voiding in a cohort of elderly and frail patients.
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Affiliation(s)
- Abel Tadrist
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | - Michael Baboudjian
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France. .,Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France. .,Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
| | - Mamadou B Bah
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France.,Department of Urology, Hôpital National Ignace Deen, Conakry, Republic of Guinea
| | | | - Florie Bottet
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | - Frederic Arroua
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | | | - Marc Fourmarier
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
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Baboudjian M, Alegorides C, Fourmarier M, Atamian A, Gondran-Tellier B, Andre M, Arroua F, Boissier R, Eghazarian C, Vidal V, Chevrot A, Droupy S, Lechevallier E. Comparison of water vapor thermal therapy and prostate artery embolization for fragile patients with indwelling urinary catheters: Preliminary results from a multi-institutional study. Prog Urol 2021; 32:115-120. [PMID: 34148768 DOI: 10.1016/j.purol.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/05/2021] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To report our preliminary experience with water vapor thermal therapy with the Rezūm™ System and Prostate Artery Embolization (PAE) for treatment of medically refractory, complete urinary retention to achieve successful cessation of catheter dependency in frail-patients. PATIENTS AND METHODS A multi-institutional study was conducted including all patients who underwent Rezūm™ procedure and PAE between October 2017 and June 2020. The included population focused on frail-patients unsuitable for conventional surgery with complete urinary retention. Rezūm™ patients were identified and matched (1:1) with patients who underwent PAE. The matching criteria were age, Charlson score, prostate volume and duration of follow-up. The primary outcome was catheter-free survival, defined as spontaneous voiding and release from catheter dependence. RESULTS Eleven patients from the Rezūm™ group were matched to 11 embolized patients. PAE and Rezūm™ patients were comparable in age (median: 77 vs. 75 years), Charlson score (median: 6 vs. 6) and prostate volume (74 vs. 60 cc). Procedures were significantly longer in the PAE group compared to the Rezūm™ procedures (median: 148 vs. 8min, P<0.001). After a median follow-up of 12 months, spontaneous voiding was conserved in all cases (100%) after the Rezūm™ procedure and in 5 cases (45.4%) after PAE (P=0.01). In catheter-free patients, the rate of benign prostatic hyperplasia medication use after procedure was 40% for PAE and 18.2% for Rezūm™ patients (P=0.54). CONCLUSIONS Our preliminary experience for treatment of complete urinary retention in frail-patients shows the feasibility of PAE and Rezūm™ to restore spontaneous urination without being associated with the occurrence of major complications. Early data suggests that Rezūm™ may provide superior results in terms of cessation of catheter dependence. Future studies are needed to definitively assess which treatment would be best suited for each patient. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- M Baboudjian
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France; Department of Urology, Hospital of Aix en Provence, Aix en Provence, France.
| | - C Alegorides
- Department of Urology, Hospital of Aix en Provence, Aix en Provence, France
| | - M Fourmarier
- Department of Urology, Hospital of Aix en Provence, Aix en Provence, France
| | - A Atamian
- Department of Urology, Hospital of Aix en Provence, Aix en Provence, France
| | - B Gondran-Tellier
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France
| | - M Andre
- Department of Radiology and Medical imaging, La Timone Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France; European Center for Medical Imaging Research CERIMED/LIIE, Marseille, France
| | - F Arroua
- Department of Urology, Hospital of Aix en Provence, Aix en Provence, France
| | - R Boissier
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France
| | - C Eghazarian
- Department of Urology, Hospital of Aix en Provence, Aix en Provence, France
| | - V Vidal
- Department of Radiology and Medical imaging, La Timone Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France; European Center for Medical Imaging Research CERIMED/LIIE, Marseille, France
| | - A Chevrot
- Department of Urology, Hospital Universitaire Carémeau de Nimes, Nimes, France
| | - S Droupy
- Department of Urology, Hospital Universitaire Carémeau de Nimes, Nimes, France
| | - E Lechevallier
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France
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Atamian A, Fourmarier M, Alegorides C, Bottet F, Arroua F, Eghazarian C, Baboudjian M. Holmium laser enucleation and water vapor thermal therapy for the treatment of symptomatic benign prostatic hyperplasia: A cost analysis. Prog Urol 2021; 32:198-204. [PMID: 34148770 DOI: 10.1016/j.purol.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To perform a cost analysis of the current gold standard operation of Holmium Laser Enucleation of the prostate (HoLEP) compared to the new technique of water vapor thermal therapy with the Rezum™ system for the treatment of symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Between October 2017 and January 2020, consecutive patients with invalidating lower urinary tract symptoms due to BPH who underwent Rezūm™ and HoLEP procedures from the Aix regional hospital were identified. The outcome of each technique was assessed in terms of cost from the institutional perspective. Detailed expense reports based were provided by the accounts department of the hospital. These were used to compare in-hospital costs for each procedure. RESULTS A total of 53 and 94 consecutive patients underwent respectively water vapor thermal therapy and HoLEP. The median costs for the surgical procedure were €1344 (IQR 1331-1361) and €669 (IQR 584-824), respectively for Rezūm™ and HoLEP (median difference €675; P<0.001). The median costs of the hospital stay were €869 (IQR 869-869) for Rezūm™ and €1295 (IQR 1295-1330) for HoLEP (median difference €426; P<0.001). Finally, the median total costs per patient were lower for HoLEP (€2005 [IQR 1902-2150]) than for Rezūm™ (€2228 [IQR 2209-2243]) procedure, and the median difference of €233 was significant (P<0.001). CONCLUSIONS One of the anticipated benefits of Rezūm™, reduced length of hospital stay with an associated reduction in cost, did not materialize within this study. The patient's clinical condition and expectations should also be taken into account when deciding between Rezum™ and standard therapies. LEVEL OF PROOF 3.
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Affiliation(s)
- A Atamian
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - M Fourmarier
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - C Alegorides
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - F Bottet
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - F Arroua
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - C Eghazarian
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - M Baboudjian
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France; Department of urology and kidney transplantation, La Conception Hospital, Aix-Marseille University, AP-HM, Marseille, France.
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9
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Baboudjian M, Fourmarier M, Gondran-Tellier B, Pradere B, Userovici M, Alegorides C, Barry Delongchamps N. Head-to-head comparison of prostatic urethral lift and water vapor thermal therapy for the treatment of symptomatic benign prostatic hyperplasia: a real-life study. Int Urol Nephrol 2021; 53:1757-1763. [PMID: 34052957 DOI: 10.1007/s11255-021-02899-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/22/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed at reporting a head-to-head comparison between water vapor thermal therapy using the Rezūm™ system and prostatic urethral lift using the Urolift™ system in men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). PATIENTS AND METHODS From December 2017 to November 2019, consecutive patients who underwent Rezūm™ and Urolift™ procedures in two urology centers have been retrospectively considered. Only patients with a prostate size less than 80 mL were included. We used the PSM method to adjust baseline differences between both groups. The co-primary endpoint included the change in International Prostate Symptom Score (IPSS) and IPSS- quality of life (QoL) from baseline to 12 months. RESULTS A total of 61 (52.1%) and 56 (47.9%) patients underwent Rezum™ and Urolift™ procedures, respectively. After PSM adjustment, 24 patients were included in both groups. No serious adverse events occurred (> Clavien II) in both groups. At 12 months, higher IPSS improvement was observed in the Rezum™ group (median:4 [IQR 3-5]) than in the Urolift™ group (median:8 [IQR 7-12]), without statistical difference (p = 0.08). The improvement in term of QoL at 12 m was similar (p = 0.43). The retreatment rates were 25% (Urolift™) and 8.3% (Rezum™), p = 0.24. Erection and ejaculatory function scores did not change significantly in either treatment group. Results in the full cohort showed that Rezum™ appeared to deliver greater improvements for IPSS and IPSS-QoL (p < 0.001 and p = 0.006, respectively) and lower reintervention rate (p = 0.006) than Urolift™. CONCLUSIONS In this small retrospective study, our results indicate that both Rezum™ and Urolift™ provide a clinically significant improvement in symptoms and QoL, although some of these improvements were greater in the Rezum™ arm. Future studies are needed to definitively assess which treatment would be best suited for each patient.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, Aix-en-Provence Hospital, Aix en Provence, France. .,Department of Urology and Kidney Transplantation, La Conception Hospital, AixMarseille University, APHM, Marseille, France.
| | - Marc Fourmarier
- Department of Urology, Aix-en-Provence Hospital, Aix en Provence, France
| | - Bastien Gondran-Tellier
- Department of Urology and Kidney Transplantation, La Conception Hospital, AixMarseille University, APHM, Marseille, France
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Mickael Userovici
- Department of Urology, Cochin Hospital, APHP, University of Paris Descartes, Paris, France
| | - Camille Alegorides
- Department of Urology, Aix-en-Provence Hospital, Aix en Provence, France
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Tzeng M, Basourakos SP, Lewicki PJ, Hu JC, Lee RK. New Endoscopic In-office Surgical Therapies for Benign Prostatic Hyperplasia: A Systematic Review. Eur Urol Focus 2021:S2405-4569(21)00056-0. [PMID: 33663982 DOI: 10.1016/j.euf.2021.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 01/19/2023]
Abstract
CONTEXT In recent years, new technologies have been developed to treat benign prostatic enlargement (BPE). Three of these devices may be utilized in office and are promising additions. OBJECTIVE To systematically review all clinical trials investigating prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), and temporary implantable nitinol device (TIND), with emphasis on clinical efficacy and complications. EVIDENCE ACQUISITION We performed a systematic review of PubMed/Medline database in November 2020 according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. EVIDENCE SYNTHESIS Of 168 articles identified, 18 met the inclusion criteria. Evidence consisted of few randomized controlled trials, and multiple single-arm prospective and retrospective studies. Among the three modalities, PUL demonstrates rare occurrence of serious complications but higher retreatment rates at short- and long-term follow-up. WVTT offers lower retreatment rates with a similar safety profile. TIND studies report varying rates of retreatment and complications. All technologies offer low rates of erectile and ejaculatory dysfunction, although the risk appears to be highest for WVTT (<10.8%). CONCLUSIONS Among the emerging technologies introduced to treat BPE, the in-office PUL, WVTT, and TIND systems are valuable additions to the current surgical options. These systems offer unique advantages that should be considered in the shared decision-making process. PATIENT SUMMARY In this report, we identified all clinical trials reporting on the efficacy and safety of the in-office prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), and temporary implantable nitinol device (TIND) systems for the treatment of benign prostatic enlargement. We found that PUL and WVTT demonstrate acceptable outcomes in terms of functional improvement, retreatment, and complications. More data with longer follow-up are required to further evaluate TIND, but early results are promising.
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Lokeshwar SD, Valancy D, Lima TFN, Blachman-Braun R, Ramasamy R. A Systematic Review of Reported Ejaculatory Dysfunction in Clinical Trials Evaluating Minimally Invasive Treatment Modalities for BPH. Curr Urol Rep 2020; 21:54. [PMID: 33104947 DOI: 10.1007/s11934-020-01012-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW To explore the sexual outcomes following the novel minimally invasive surgical procedures for benign prostatic hyperplasia- (BPH-) related lower urinary tract symptoms (LUTS), with an emphasis on ejaculatory dysfunction (EjD). RECENT FINDINGS A database search with a 10-year time restriction was carried out until February 20, 2020 using MEDLINE through the PubMed Platform evaluating minimally invasive treatment modalities for BPH and their effect on EjD. After the article selection, we retrieved data for men randomized in 19 different studies with results in 40 separate published articles investigating minimally invasive BPH surgery and reporting EjD rates. To date, water vapor thermal therapy or Rezūm, prostatic urethral lift (PUL) or UroLift®, prostate artery embolization (PAE), and Aquablation showed acceptable rates (< 2%) of retrograde ejaculation by 1 year and had very low adverse events related to the procedure. Both PUL and Rezūm demonstrated lower rates when compared with PAE and Aquablation. With comparable sexual side effect profiles postoperatively, clinicians may determine which therapeutic modality is optimal for patients based on efficacy and cost-benefit. Further randomized clinical trials are required to directly compare the effect of novel minimally invasive surgical procedures for BPH-related LUTS on ejaculation and sexual function.
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Affiliation(s)
- Soum D Lokeshwar
- Department of Urology, Yale Univeristy School of Medicine, 333 Cedar Street, New Haven, CT, 06520-8058, USA
| | - David Valancy
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Thiago Fernandes Negris Lima
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Ruben Blachman-Braun
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA.
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