Feasibility of outpatient daycase local anaesthestic Rezūm™ without sedation

S. Khadhouri; S. Guillaumier; L. Drummond; B. Dreyer; C. Clelland; F Al Jaafari

doi:10.1186/s12894-024-01471-2

Feasibility of outpatient daycase local anaesthestic Rezūm™ without sedation

S. Khadhouri^*, S. Guillaumier, L. Drummond, B. Dreyer, C. Clelland, F Al Jaafari

^*Corresponding author for this work

School of Medicine

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Abstract

Background
Rezūm™ is a relatively new bladder outflow obstruction (BOO) procedure that uses thermal energy through water vapour to cause necrosis of prostatic tissue. The standard delivery of this treatment is in an operating theatre under a general or spinal anaesthetic, or under local anaesthetic with sedation that requires patient monitoring.

Methods
We propose an outpatient daycase method of delivering Rezūm™ under local anaesthetic without sedation, using a prostatic local anaesthetic block and cold local anaesthetic gel instillation into the urethra.

Results
Preliminary results of our first thirteen patients demonstrate the feasibility of this new technique, with a mean pain score of 2.1 out of 10 on a visual analogue scale, a successful trial without catheter in all 13 patients (one patient voided successfully on second trial), a reduction in mean International Prostate Symptom Score (IPSS) from 20.6 to 5.4, and improvement in maximum flow from 8.8 ml/s to 14.4 ml/s. The complications were minor (Clavien-Dindo less than III) and included a UTI, minor bleeding not requiring admission, and retrograde ejaculation.

Conclusions
We demonstrate that an outpatient local anaesthetic daycase service without sedation is feasible. This can be delivered in a clinic setting, reduce waiting times for BOO surgery, and increase availability of operating theatre for other general anaesthetic urological procedures.

Original language	English
Journal	BMC Urology
Volume	24
DOIs	https://doi.org/10.1186/s12894-024-01471-2
Publication status	Published - 4 Apr 2024

Keywords

Rezum
Local anaesthetic
Outpatient
Daycase
Bladder outflow obstruction surgery
Minimally invasive surgical treatment
BOO
BOO surgery
MIST

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Khadhouri_2024_BMC-U_Outpatient-daycase_CC
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title = "Feasibility of outpatient daycase local anaesthestic Rezūm{\texttrademark} without sedation",

abstract = "BackgroundRezūm{\texttrademark} is a relatively new bladder outflow obstruction (BOO) procedure that uses thermal energy through water vapour to cause necrosis of prostatic tissue. The standard delivery of this treatment is in an operating theatre under a general or spinal anaesthetic, or under local anaesthetic with sedation that requires patient monitoring.MethodsWe propose an outpatient daycase method of delivering Rezūm{\texttrademark} under local anaesthetic without sedation, using a prostatic local anaesthetic block and cold local anaesthetic gel instillation into the urethra.ResultsPreliminary results of our first thirteen patients demonstrate the feasibility of this new technique, with a mean pain score of 2.1 out of 10 on a visual analogue scale, a successful trial without catheter in all 13 patients (one patient voided successfully on second trial), a reduction in mean International Prostate Symptom Score (IPSS) from 20.6 to 5.4, and improvement in maximum flow from 8.8 ml/s to 14.4 ml/s. The complications were minor (Clavien-Dindo less than III) and included a UTI, minor bleeding not requiring admission, and retrograde ejaculation.ConclusionsWe demonstrate that an outpatient local anaesthetic daycase service without sedation is feasible. This can be delivered in a clinic setting, reduce waiting times for BOO surgery, and increase availability of operating theatre for other general anaesthetic urological procedures.",

keywords = "Rezum, Local anaesthetic, Outpatient, Daycase, Bladder outflow obstruction surgery, Minimally invasive surgical treatment, BOO, BOO surgery, MIST",

author = "S. Khadhouri and S. Guillaumier and L. Drummond and B. Dreyer and C. Clelland and Jaafari, {F Al}",

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doi = "10.1186/s12894-024-01471-2",

language = "English",

volume = "24",

journal = "BMC Urology",

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T1 - Feasibility of outpatient daycase local anaesthestic Rezūm™ without sedation

AU - Khadhouri, S.

AU - Guillaumier, S.

AU - Drummond, L.

AU - Dreyer, B.

AU - Clelland, C.

AU - Jaafari, F Al

PY - 2024/4/4

Y1 - 2024/4/4

N2 - BackgroundRezūm™ is a relatively new bladder outflow obstruction (BOO) procedure that uses thermal energy through water vapour to cause necrosis of prostatic tissue. The standard delivery of this treatment is in an operating theatre under a general or spinal anaesthetic, or under local anaesthetic with sedation that requires patient monitoring.MethodsWe propose an outpatient daycase method of delivering Rezūm™ under local anaesthetic without sedation, using a prostatic local anaesthetic block and cold local anaesthetic gel instillation into the urethra.ResultsPreliminary results of our first thirteen patients demonstrate the feasibility of this new technique, with a mean pain score of 2.1 out of 10 on a visual analogue scale, a successful trial without catheter in all 13 patients (one patient voided successfully on second trial), a reduction in mean International Prostate Symptom Score (IPSS) from 20.6 to 5.4, and improvement in maximum flow from 8.8 ml/s to 14.4 ml/s. The complications were minor (Clavien-Dindo less than III) and included a UTI, minor bleeding not requiring admission, and retrograde ejaculation.ConclusionsWe demonstrate that an outpatient local anaesthetic daycase service without sedation is feasible. This can be delivered in a clinic setting, reduce waiting times for BOO surgery, and increase availability of operating theatre for other general anaesthetic urological procedures.

AB - BackgroundRezūm™ is a relatively new bladder outflow obstruction (BOO) procedure that uses thermal energy through water vapour to cause necrosis of prostatic tissue. The standard delivery of this treatment is in an operating theatre under a general or spinal anaesthetic, or under local anaesthetic with sedation that requires patient monitoring.MethodsWe propose an outpatient daycase method of delivering Rezūm™ under local anaesthetic without sedation, using a prostatic local anaesthetic block and cold local anaesthetic gel instillation into the urethra.ResultsPreliminary results of our first thirteen patients demonstrate the feasibility of this new technique, with a mean pain score of 2.1 out of 10 on a visual analogue scale, a successful trial without catheter in all 13 patients (one patient voided successfully on second trial), a reduction in mean International Prostate Symptom Score (IPSS) from 20.6 to 5.4, and improvement in maximum flow from 8.8 ml/s to 14.4 ml/s. The complications were minor (Clavien-Dindo less than III) and included a UTI, minor bleeding not requiring admission, and retrograde ejaculation.ConclusionsWe demonstrate that an outpatient local anaesthetic daycase service without sedation is feasible. This can be delivered in a clinic setting, reduce waiting times for BOO surgery, and increase availability of operating theatre for other general anaesthetic urological procedures.

KW - Rezum

KW - Local anaesthetic

KW - Outpatient

KW - Daycase

KW - Bladder outflow obstruction surgery

KW - Minimally invasive surgical treatment

KW - BOO

KW - BOO surgery

KW - MIST

U2 - 10.1186/s12894-024-01471-2

DO - 10.1186/s12894-024-01471-2

M3 - Article

SN - 1471-2490

VL - 24

JO - BMC Urology

JF - BMC Urology

ER -

Feasibility of outpatient daycase local anaesthestic Rezūm™ without sedation

Abstract

Keywords

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