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Rezum® water vapor therapy for lower urnary tract symptoms secondary to benign prostatic hyperplasia : 4-year outcomes, sexual impact and retreatment rates
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Objetivos: Analisar a eficácia da terapia de vapor de água Rezum® na redução dos sintomas do trato urinário inferior relacionados com a hiperplasia benigna da próstata e avaliar a segurança, o impacto na função erétil e ejaculatória e as taxas de retratamento. Métodos: Um estudo observacional retrospetivo de 145 homens consecutivos, que foram submetidos à terapia Rezum® e seguidos durante 4 anos, num estudo de um único centro. Foram utilizadas medidas de resultados incluindo IPSS e IPSS-QoL, IIEF5 e MSHQEjD para avaliar a disfunção erétil e a disfunção ejaculatória. As complicações foram avaliadas de acordo com a escala de Clavien-Dindo e foram determinadas as taxas de retratamento. Resultados: A coorte tinha uma idade média de 63,3 anos e o volume médio da próstata era de 58,7cc (IQR 41,8-70). Observaram-se melhorias clínicas e estatísticas significativas no IPSS durante o seguimento: uma redução de 52,2%, 49,5%, 34,4%, 41,3% e 33,4% aos 3 meses, 1 ano, 2 anos, 3 anos e 4 anos, respetivamente. A QoL também melhorou significativamente nos pontos de tempo de acompanhamento. A função erétil avaliada pelo IIEF5 não mostrou diferenças significativas. 11,7% da coorte relatou ter experimentado ejaculação retrógrada após o procedimento. Não foram observados eventos com um grau de Clavien-Dindo superior a 2. Houve retenção urinária em 9,5% da coorte, com uma duração média de cateterização de 6,8 dias. A taxa de retratamento cirúrgico foi de 12,4% em 4 anos. Conclusão: O Rezum® demonstrou melhorias clínicas significativas na redução dos sintomas do trato urinário associados à hiperplasia benigna da próstata. Demonstrando segurança com complicações mínimas, e sem grande impacto na vida sexual, a taxa de retratamento e a ejaculação retrógrada foram mais elevadas do que o previsto.
Objective: To analyse the efficacy of Rezum® water vapor therapy in reducing lower urinary tract symptoms related to benign prostatic hyperplasia and assess safety, erectile and ejaculatory impact and retreatment rates. Methods: A retrospective observational study of 145 consecutive men, who went under Rezum® therapy had a 4 year follow-up period, in a single-centre study. Outcome measures including IPSS and IPSS-QoL, IIEF5 and MSHQEjD were used to evaluate erectile dysfunction and ejaculatory dysfunction. Complications were assessed according to Clavien-Dindo scale and retreatment rates were determined. Results: The cohort had a mean age of 63.3 years and the mean Prostate Volume of 58.7cc (IQR 41,8-70) Significant clinical and statistical ameliorations were observed in IPSS over the follow-up: a reduction of 52.2%, 49.5%, 34.4%, 41.3%, and 33.4% at 3 months, 1 year, 2 years, 3 years, and 4 years, respectively. QoL also significantly improved at follow-up time points. Erectile function evaluated by the IIEF5 didn’t show significant differences. 11.7% of the cohort reported experiencing retrograde ejaculation afer the procedure. No events with a Clavien-Dindo grade higher than 2 were observed. Urinary retention occurred in 9.5% of the cohort, with a median catheterization duration of 6.8 days. Surgical retreatment rate was 12.4% over 4 years. Conclusion: The Rezum System® demonstrated significant and sustained clinical improvements in lowering urinary tract symptoms associated with benign prostatic hyperplasia. While showing safety with minimal complications, and little impact in sexual life, retreatment rate and retrograde ejaculation were higher than anticipated.
Objective: To analyse the efficacy of Rezum® water vapor therapy in reducing lower urinary tract symptoms related to benign prostatic hyperplasia and assess safety, erectile and ejaculatory impact and retreatment rates. Methods: A retrospective observational study of 145 consecutive men, who went under Rezum® therapy had a 4 year follow-up period, in a single-centre study. Outcome measures including IPSS and IPSS-QoL, IIEF5 and MSHQEjD were used to evaluate erectile dysfunction and ejaculatory dysfunction. Complications were assessed according to Clavien-Dindo scale and retreatment rates were determined. Results: The cohort had a mean age of 63.3 years and the mean Prostate Volume of 58.7cc (IQR 41,8-70) Significant clinical and statistical ameliorations were observed in IPSS over the follow-up: a reduction of 52.2%, 49.5%, 34.4%, 41.3%, and 33.4% at 3 months, 1 year, 2 years, 3 years, and 4 years, respectively. QoL also significantly improved at follow-up time points. Erectile function evaluated by the IIEF5 didn’t show significant differences. 11.7% of the cohort reported experiencing retrograde ejaculation afer the procedure. No events with a Clavien-Dindo grade higher than 2 were observed. Urinary retention occurred in 9.5% of the cohort, with a median catheterization duration of 6.8 days. Surgical retreatment rate was 12.4% over 4 years. Conclusion: The Rezum System® demonstrated significant and sustained clinical improvements in lowering urinary tract symptoms associated with benign prostatic hyperplasia. While showing safety with minimal complications, and little impact in sexual life, retreatment rate and retrograde ejaculation were higher than anticipated.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Hiperplasia benigna da próstata Sintomas do trato urinário inferior Terapia de vapor de água Função ejaculatória Função sexual Urologia