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Clinical history:
57 years old, male.
40g prostate volume.
Mild LUTS.
The patient is interested in preserving the anterograde ejaculation and going back to work as soon as possible.
Other history:
No allergies
No other surgeries.
Taking Tamsulosin for his LUTS and Candesartan for his blood pressure
Technique description:
Rezūm Water Vapor Therapy utilizes convective radiofrequency to create stored thermal energy in the form of steam, which is delivered transurethrally into the transition zone of the prostate to ablate tissue, thereby reducing LUTS. In other words, upon contact with body-temperature tissue, the water vapor then condenses. This phase shift to a liquid state dispenses concentrated energy onto the cell membranes of the target tissue, triggering instant cell necrosis.
Typically it does not require general anesthesia.
Symptoms relief are usually noticed within the first three months after the procedure and it has also been shown to preserve sexual function through five years after the procedure.
Procedure steps:
Perform a transrectal prostate block with Lidocaine 2%
Scrub and prepare the sterile field and the system: the system comprises a radio frequency (RF) generator and a single-use transurethral delivery device. To incorporate the standard 4 mm 30-degree cystoscopy lens, use a bit of lubricant.
Perform the priming steps, following the instructions of Rezūm generator
Introduce the transurethral delivery device smoothly until the bladder neck.
Measure the distance from the bladder neck to colicullum, taking into account that the distance between the needle and arms (1FOV) is 0.5cm, and plan the number of injections to be delivered: 1 injection every 2cm.
The treatment begins with the needle tip visually positioned and inserted beginning approximately 1 cm distal to the bladder neck.
The treatment needle is retracted after each vapor injection and repositioned in 2 cm increments distally from the previous site to the end of the prostatic tissue just proximal to the verumontanum.
In the case of the middle lobe, treat it with a 45-degree angle.
Retire the device and insert a catheter
Training Objectives:
Candidate selections.
Know how to perform the procedure.
Postoperative care.
