Treatment cycles per unit prostate volume (CPV) for transurethral water vapor therapy (Rezūm) in catheter-dependent patients.

IF 5.8 2区医学 Q1 ONCOLOGY

Prostate Cancer and Prostatic Diseases Pub Date : 2025-05-16 DOI:10.1038/s41391-025-00979-4

Brian W H Siu, Alex Q Liu, Chi Ho Leung, Steffi K K Yuen, David K W Leung, Chris H M Wong, Ivan C H Ko, Jeremy M H Ho, Ryan W Y Yuen, Henry Y H Meng, Yvonne Y Y Chan, Chi Hang Yee, Jeremy Y C Teoh, Chi Fai Ng, Peter K F Chiu, Lo Ka Lun

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引用次数: 0

Abstract

Background: For transurethral water vapor therapy (Rezūm), the number of water vapor treatment cycles has classically been determined by the prostate length, or the fields of vision (FOV). Apart from treating lower urinary tract symptoms, there is emerging evidence on Rezūm for refractory retention. We aim to investigate the optimal number of treatment cycles for Rezūm in catheter-dependent refractory retention.

Methods: From 02/2021 to 09/2023, 168 consecutive catheter-dependent patients undergoing Rezūm at three centres were included in this prospective registry. Treatment Cycles Per Unit Prostate Volume (CPV) was calculated by dividing the number of treatment cycles by the prostate size. After propensity score matching of age and prostate size, 144 patients were analyzed in the CPV ≤ 0.15 and CPV > 0.15 groups in 1:1 ratio. The primary outcome was the International Prostate Symptom Score (IPSS) at 1-year follow-up. Secondary outcomes included catheter removal time, 30-day readmission rates, prostate-specific antigen (PSA) reduction. Logistic regression model and linear mixed model were used.

Results: The CPV > 0.15 group demonstrated significantly better IPSS at 1-year follow-up (adjusted mean difference -2.8 points, p = 0.040), and lower 30-day readmission rates (4.2% vs 16.7%, OR 0.22, p = 0.029). Greater PSA reduction was observed in the higher CPV group at 3 months (adjusted mean difference of log-transformed PSA: -0.4 ng/ml, p = 0.022). Median catheter removal times were 14 days (interquartile range 9-29 days) and 15 days (interquartile range 12-40 days) for lower and higher CPV groups respectively (p = 0.059). Six-week IPSS and IPSS-QoL (quality of life score) were similar (p = 0.359 and p = 0.464 respectively).

Conclusion: Higher CPV (>0.15) in Rezūm demonstrated superior 1-year IPSS, lower 30-day readmission rates in our matched cohort. A more aggressive treatment approach, contrasting to the standard FOV-based approach, may benefit catheter-dependent patients.

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导管依赖患者经尿道水蒸气治疗每单位前列腺体积（CPV）的治疗周期（Rezūm）。

背景：对于经尿道水蒸汽疗法（Rezūm），水蒸汽治疗周期的次数通常由前列腺长度或视野（FOV）决定。除了治疗下尿路症状外，Rezūm治疗难治性尿潴留的证据也越来越多。我们的目的是研究Rezūm在导管依赖性难治性潴留的最佳治疗周期数。方法：从2021年2月至2023年9月，168名连续导管依赖患者在三个中心接受Rezūm治疗，纳入前瞻性登记。单位前列腺体积治疗周期（CPV）由治疗周期数除以前列腺大小计算。将年龄与前列腺大小进行倾向评分匹配后，按1:1的比例将144例患者分为CPV≤0.15组和CPV > 0.15组进行分析。主要终点是1年随访时的国际前列腺症状评分（IPSS）。次要结局包括拔管时间、30天再入院率、前列腺特异性抗原（PSA）降低。采用Logistic回归模型和线性混合模型。结果：CPV > 0.15组在1年随访时IPSS明显改善（调整平均差值-2.8点，p = 0.040）， 30天再入院率明显降低（4.2% vs 16.7%, OR 0.22, p = 0.029）。高CPV组在3个月时观察到更大的PSA降低（对数转换PSA的调整平均差：-0.4 ng/ml, p = 0.022）。低CPV组和高CPV组的中位拔管时间分别为14天（9 ~ 29天）和15天（12 ~ 40天）（p = 0.059）。6周IPSS和IPSS- qol（生活质量评分）相似（p = 0.359和p = 0.464）。结论：在我们匹配的队列中，Rezūm患者较高的CPV（>0.15）表现出较好的1年IPSS，较低的30天再入院率。与标准的基于fov的治疗方法相比，更积极的治疗方法可能对导管依赖患者有益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学

CiteScore

10.00

自引率

6.20%

发文量

142

审稿时长

6-12 weeks

期刊介绍： Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.