Prostate steam treatment

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Prostate steam treatment
Other namesWater vapor thermal therapy
Specialty Urology

Prostate steam treatment (Rezum), also called water vapor thermal therapy (WVTT), is a minimally invasive surgical procedure for men with lower urinary tract symptoms resulting from prostate enlargement (benign prostatic hyperplasia, BPH). It uses injections of steam to remove obstructive prostate tissue from the inside of the organ without injuring the prostatic part of the urinary tube (prostatic urethra). [1]

Contents

History

The Rezum system was introduced by NxThera (Maple Grove, Minnesota, US). It was approved by the United States Food and Drug Administration in 2015 [2] and the National Institute for Health and Care Excellence (NICE) of the UK in 2018. [3] As of August 2018 the system was in use in 5 National Health Service hospitals in England, and due to be implemented in a further 15. [3]

Procedure

It is an outpatient or office-based procedure. The equipment consists of a vapor generator and a transurethral delivery device. The latter is similar to a cystoscope with an optical system with a 90° extending retractable 10.25 mm long injection needle (diameter 1.3 mm). From this needle water vapor is circumferentially delivered via 12 holes at the needle’s tip. Depending on the size of the prostate an adequate number of injections is delivered to the two side lobes and to the middle lobe of the prostate. Each injection lasts 9 seconds and the space between adjacent injections is about 10 mm.[ citation needed ]

Upon condensation of the vapor upon cell membranes, cell death and necrosis occur immediately. Over a period of about three months the dead cells are removed by the body, thus shrinking the prostate and relieving BPH symptoms. [4]

Benefits

The effects of the treatment were investigated by one randomized controlled trial (RCT) with a follow-up of three months and several observational studies with follow-ups of up to four years.[ citation needed ]

The RCT from 2016 comparing prostate steam treatment to a sham procedure (a placebo) found three months after the operation with moderate certainty that this procedure may improve quality of life for men with moderate urinary symptoms. [5] [6]

Observational studies showed positive outcomes up to four years of follow-up. [4] [7] Water vapor thermal therapy was looked at in larger volume prostates (>80 mL) and in those with middle lobes protruding into the bladder and appears to work. [4] The procedure has been shown to not affect sexual function across a few studies. [4] [8] [2] [9] [10]

Related Research Articles

<span class="mw-page-title-main">Benign prostatic hyperplasia</span> Noncancerous increase in size of the prostate gland

Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control. Complications can include urinary tract infections, bladder stones, and chronic kidney problems.

<span class="mw-page-title-main">Urinary retention</span> Inability to completely empty the bladder

Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladder control, mild lower abdominal pain, and a weak urine stream. Those with long-term problems are at risk of urinary tract infections.

<span class="mw-page-title-main">Transurethral resection of the prostate</span> Surgical procedure to perform a prostatectomy

Transurethral resection of the prostate is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. It has been the standard treatment for BPH for many years, but recently alternative, minimally invasive techniques have become available. This procedure is done with spinal or general anaesthetic. A triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete.The outcome is considered excellent for 80–90% of BPH patients. The procedure carries minimal risk for erectile dysfunction, moderate risk for bleeding, and a large risk for retrograde ejaculation.

<span class="mw-page-title-main">Prostatectomy</span> Surgical removal of all or part of the prostate gland

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Alpha-1 blockers constitute a variety of drugs that block the effect of catecholamines on alpha-1-adrenergic receptors. They are mainly used to treat benign prostatic hyperplasia (BPH), hypertension and post-traumatic stress disorder. Alpha-1 adrenergic receptors are present in vascular smooth muscle, the central nervous system, and other tissues. When alpha blockers bind to these receptors in vascular smooth muscle, they cause vasodilation.

Nocturia is defined by the International Continence Society (ICS) as “the complaint that the individual has to wake at night one or more times for voiding .” The term is derived from Latin nox, night, and Greek [τα] ούρα, urine. Causes are varied and can be difficult to discern. Although not every patient needs treatment, most people seek treatment for severe nocturia, waking up to void more than 2–3 times per night.

<span class="mw-page-title-main">Tamsulosin</span> Uroselective alpha 1 blocker

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Prostatic congestion is a medical condition of the prostate gland that happens when the prostate becomes swollen by excess fluid and can be caused by prostatosis. The condition often results in a person with prostatic congestion feeling the urge to urinate frequently. Prostatic congestion has been associated with prostate disease, which can progress due to age. Oftentimes, the prostate will grow in size which can lead to further problems, such as prostatitis, enlarged prostate, or prostate cancer.

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A prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms (LUTS). Prostatic obstruction is a common condition with a variety of causes. Benign prostatic hyperplasia (BPH) is the most common cause, but obstruction may also occur acutely after treatment for BPH such as transurethral needle ablation of the prostate (TUNA), transurethral resection of the prostate (TURP), transurethral microwave thermotherapy (TUMT), prostate cancer or after radiation therapy.

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<span class="mw-page-title-main">Transurethral microwave thermotherapy</span> Medical procedure

Transurethral microwave thermotherapy (TUMT) is one of a number of effective and safe procedures used in the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia. It is an alternative treatment to pharmacotherapy such as alpha blockers, transurethral resection of the prostate (TURP), transurethral needle ablation of the prostate, photoselective vaporization of the prostate and prostatic removal or prostatectomy.

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<span class="mw-page-title-main">Prostatic artery embolization</span> Non-surgical technique for treatment of benign prostatic hypertrophy

Prostatic artery embolization is a non-surgical technique for treatment of benign prostatic hypertrophy (BPH).

<span class="mw-page-title-main">Surgery for benign prostatic hyperplasia</span> Type of surgery

If medical treatment is not effective, surgery may need to be performed for benign prostatic hyperplasia.

Aquablation therapy (AquaBeam) is a surgical procedure for men with lower urinary tract symptoms resulting from benign prostatic hyperplasia (BPH). It is in the early stages of study. It is not categorized as minimally invasive as general anesthesia is required. The procedure was developed by PROCEPT BioRobotics and combines real-time visualization through a cystoscope and a bi-plane ultrasound, while using a high-velocity sterile saline heat-free waterjet and autonomous robotics to remove prostate tissue.

Prostatic urethral lift is a minimally invasive procedure for the treatment of benign prostatic hyperplasia. This procedure can be done under local anesthesia in an outpatient consultation.

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References

  1. ↑ Ulchaker JC, Martinson MS (2018). "Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia". ClinicoEconomics and Outcomes Research. 10: 29–43. doi: 10.2147/CEOR.S148195 . PMC   5749396 . PMID   29343977.
  2. 1 2 Westwood J, Geraghty R, Jones P, Rai BP, Somani BK (November 2018). "Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia". Therapeutic Advances in Urology. 10 (11): 327–333. doi:10.1177/1756287218793084. PMC   6180381 . PMID   30344644.
  3. 1 2 National Institute for Health and Care Excellence (NICE): Rezum for treating benign prostatic hyperplasia, Medtech innovation briefing, 24 August 2018 (containing also information on costs and cost effectiveness).
  4. 1 2 3 4 Pham H, Sharma P (April 2018). "Emerging, newly-approved treatments for lower urinary tract symptoms secondary to benign prostatic hypertrophy". The Canadian Journal of Urology. 25 (2): 9228–9237. PMID   29679999.
  5. ↑ Kang TW, Jung JH, Hwang EC, Borofsky M, Kim MH, Dahm P (March 2020). Cochrane Urology Group (ed.). "Convective radiofrequency water vapour thermal therapy for lower urinary tract symptoms in men with benign prostatic hyperplasia". The Cochrane Database of Systematic Reviews. 2020 (3): CD013251. doi:10.1002/14651858.CD013251.pub2. PMC   7093307 . PMID   32212174.
  6. ↑ McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND; et al. (2016). "Minimally Invasive Prostate Convective Water Vapor Energy Ablation: A Multicenter, Randomized, Controlled Study for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia". J Urol. 195 (5): 1529–1538. doi:10.1016/j.juro.2015.10.181. PMID   26614889.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ↑ Doppalapudi SK, Gupta N (2021). "What Is New with Rezūm Water Vapor Thermal Therapy for LUTS/BPH?". Curr Urol Rep. 22 (1): 4. doi:10.1007/s11934-020-01018-6. PMID   33403529. S2CID   230783957.
  8. ↑ McVary KT, Rogers T, Mahon J, Gupta NK (December 2018). "Is Sexual Function Better Preserved After Water Vapor Thermal Therapy or Medical Therapy for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia?". The Journal of Sexual Medicine. 15 (12): 1728–1738. doi: 10.1016/j.jsxm.2018.10.006 . PMID   30446471.
  9. ↑ Leong JY, Patel AS, Ramasamy R (September 2019). "Minimizing Sexual Dysfunction in BPH Surgery". Current Sexual Health Reports. 11 (3): 190–200. doi:10.1007/s11930-019-00210-1. PMC   6714584 . PMID   31467497.
  10. ↑ Miller LE, Chughtai B, McVary K, Gonzalez RR, Rojanasarot S, DeRouen K, Bhattacharyya S (July 2020). "Water vapor thermal therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia: Systematic review and meta-analysis". Medicine. 99 (30): e21365. doi:10.1097/MD.0000000000021365. PMC   7387023 . PMID   32791742.
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