Photo Credit: Andrei Novozhilov
The following is a summary of “Feasibility of outpatient day case local anesthetic Rezūm™ without sedation,” published in the April issue of Urology by Khadhouri et al.
Rezūm™ represents a novel approach to treating bladder outflow obstruction (BOO) by employing thermal energy in the form of water vapor to induce necrosis of prostatic tissue. Conventionally, this treatment is administered in an operating theater under either general or spinal anesthesia or local anesthesia accompanied by sedation, necessitating patient monitoring throughout the procedure. In this study, the researchers propose an outpatient day case protocol for delivering Rezūm™ under local anesthesia without sedation, facilitated by a prostatic local anesthetic block and the instillation of cold local anesthetic gel into the urethra. The initial experience with thirteen patients underscores the feasibility of this innovative technique.
Notably, patients reported a mean pain score of 2.1 out of 10 on a visual analog scale, achieved successful voiding without a catheter in all cases (with one patient succeeding on the second attempt), experienced a notable reduction in mean International Prostate Symptom Score (IPSS) from 20.6 to 5.4, and demonstrated improvement in maximum flow rates from 8.8 ml/s to 14.4 ml/s. Notably, observed complications were minor, falling below Clavien-Dindo Grade III, and included a urinary tract infection (UTI), minor bleeding not requiring hospital admission and retrograde ejaculation.
Their findings underscore the viability of an outpatient local anesthetic day case service devoid of sedation. This approach, which can be conveniently implemented in a clinic setting, holds the potential to alleviate waiting times for BOO surgery and free up operating theater resources for other urological procedures necessitating general anesthesia.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01471-2
