PDF(Pubmed)
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.
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.
摘要：
背景：Rezüm™是一种相对较新的膀胱流出梗阻（BOO）手术，该手术利用热能通过水蒸气引起前列腺组织坏死。这种治疗的标准实施是在手术室中进行全身麻醉或脊柱麻醉，或在需要患者监测的局部麻醉下进行镇静。
方法：我们提出了一种门诊日间方法，在局部麻醉下无镇静作用下提供Rezm™，使用前列腺局部麻醉块和冷局部麻醉凝胶滴入尿道。
结果：我们最初的13例患者的初步结果证明了这种新技术的可行性，视觉模拟量表上的平均疼痛评分为10分之2.1，在所有13名患者中进行了无导管的成功试验（一名患者在第二次试验中成功排泄），平均国际前列腺症状评分（IPSS）从20.6降低到5.4，最大流量从8.8ml/s提高到14.4ml/s。并发症较小（Clavien-Dindo小于III），包括UTI，轻微出血不需要入院，逆行射精.
结论：我们证明了不使用镇静的门诊局部麻醉日间服务是可行的。这可以在诊所提供，减少BOO手术的等待时间，并增加手术室用于其他全身麻醉泌尿外科手术的可用性。
方法：我们提出了一种门诊日间方法，在局部麻醉下无镇静作用下提供Rezm™，使用前列腺局部麻醉块和冷局部麻醉凝胶滴入尿道。
结果：我们最初的13例患者的初步结果证明了这种新技术的可行性，视觉模拟量表上的平均疼痛评分为10分之2.1，在所有13名患者中进行了无导管的成功试验（一名患者在第二次试验中成功排泄），平均国际前列腺症状评分（IPSS）从20.6降低到5.4，最大流量从8.8ml/s提高到14.4ml/s。并发症较小（Clavien-Dindo小于III），包括UTI，轻微出血不需要入院，逆行射精.
结论：我们证明了不使用镇静的门诊局部麻醉日间服务是可行的。这可以在诊所提供，减少BOO手术的等待时间，并增加手术室用于其他全身麻醉泌尿外科手术的可用性。
