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Rezum treatment for BPH

Boston Scientific

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2019

Dr. Christopher Cantrill showcases three different cases in which performs Rezum Treatment for BPH, as part of the AIS Urological Series.

Clinical Case:

Clinical History:

Prostate Ultrasound shows a 45-gram gland with a 48-degree urethral angle
Cystoscopy demonstrated lateral lobe obstruction with central tissue elevation and moderate trabeculations of the bladder
Uroflow showed Qmax 11.3 and Qave 4.2 with PVR of 50 and 155 cc voided

Clinical Case:

76 y.o. Male
Urgency and occasional UUI, slow stream, hesitancy and nocturia
He is on dual therapy with flomax and finasteride and complains of ED and slowly progressive urinary symptoms
IPSS score is 12 with a bother score of 2

Clinical History:

Cystoscopy showed lateral lobe obstruction, no presence of a median lobe. Moderate trabeculations present
Uroflow was 173 cc with Qmax 9.3 and Qave of 3cc with PVR of 350. UDS also showed some overactivity and pDet of 35 showing some impaired contractility of the bladder and uninhibited contractions under study
The patient was counselled that he had both outlet and prostate symptoms and may require further intervention for his symptoms. He was also informed he was off label for therapy given his PVR but he did not want to pursue other outlet surgeries at that time

Clinical Case:

75 y.o. Male
Long-standing LUTS
Complains of weak stream, frequency every 1-2 hours, nocturia x 3 and hesitancy.
He Is on dual therapy with finasteride and 0.8 mg of flomax and complains of anejaculation.
IPSS score Is 16 with a bother score of 5

Clinical History:

Prostate Ultrasound shows a 40-gram gland with a 50-degree urethral angle
Cystoscopy demonstrated lateral lobe obstruction with a true median lobe present but no Intravesical protrusion noted, moderate trabeculations
Uroflow demonstrated Qmax 9.6 cc/sec and Qave 5.5cc/sec with PVR of 142cc with 355 cc voided

Procedure steps:

Proper work-up with H and P, IPSS score, PVR, TRUS, cysto, and uroflow
Review of work-up for pretreatment pant
Anesthesia with a TRUS guided-modified periprostatic block and urethral lidocaine
Ensuring good lithotomy position prior to scope Insertion
Measuring the prostatic fossa from bladder neck to veru and determining need for central treatment
Minimize excess movements to reduce procedural bleeding
Placement of foley catheter for bladder drainage following therapy