P3-3 Tolerability of Rezūm steam ablation using transrectal ultrasound guided periprostatic nerve block
Published Date: 21st June 2021
Publication Authors: Napier-Hemy TP, Starmer B, McCabe JE
Introduction
Rezūm is a widely adopted minimally invasive treatment for LUTS BPH. It is conventionally performed under GA, regional anaesthesia or heavy sedation. Performing it in a safe and tolerable way under local anaesthesia would be advantageous for treating high risk patients and allow administration in an outpatient setting.
Patients and Methods
Patients underwent LA Rezūm by a single surgeon between 30/07/2020 and 21/12/2020. Transperineal injection of 1% lidocaine and 0.5% levobupivacaine mix was administered in to the periprostatic neurovascular bundles via PrecisionPoint, using transrectal ultrasound. Additionally, cooled lidocaine gel was administered transurethrally. Patients completed a questionnaire using visual analogue scales (VAS), assessing tolerability. The same questionnaire had previously been used to compare TRUS vs LA transperineal biopsy (LATP) tolerability and these results acted as comparative control.
Results
27 patients, median age 67 and median prostate volume 47cc. Overall median VAS (0-9) for TRUS probe insertion, LA injection and injection of steam were 5, 4 and 4 respectively.
On a VAS of 0-3, 94% described the procedure as either a ‘minor (0)’ or ‘moderate (1)’ procedure which was tolerable under LA. One patient was unable to tolerate the procedure (abandoned at TRUS insertion). Tolerance was not significantly affected by age. Fewer steam cycles improved tolerance score. Control group median VAS (0-9) for TRUS and LATP biopsy tolerance was 3 and 4.
Conclusion
Rezūm is a feasible approach for the management of obstructive lower urinary tract symptoms, in carefully selected patients, when performed under local anaesthetic.
Napier-Hemy, T; Starmer, B; McCabe, J. (2021). P3-3 Tolerability of Rezūm steam ablation using transrectal ultrasound guided periprostatic nerve block. Journal of Clinical Urology. 14 (1), 19