Transurethral water vapour thermal therapy effective and safe in Chinese BPH patients

Transurethral water vapour thermal therapy (WVTT) delivered in an office-based setting under local anaesthesia alone is an effective and safe alternative for surgical treatment of benign prostatic hyperplasia (BPH) in Chinese patients, researchers from the Chinese University of Hong Kong (CUHK) have reported.

In this first study on office-based transurethral WVTT under local anaesthesia alone in Asian patients, the researchers retrospectively reviewed data from 50 Chinese BPH patients (median age, 71.5 years) with clinical indications for surgical treatment (ie, acute retention of urine [AROU] or lower urinary tract symptoms) in Hong Kong between June 2020 and December 2021. Patients with active urinary tract problems and urological malignancies were excluded. [Hong Kong Med J 2024;doi:10.12809/hkmj2210330]

Among the 50 patients in the study, 27 (54 percent) had symptomatic BPH, 13 (26 percent) had AROU with a urethral catheter, and 10 (20 percent) had AROU without a urethral catheter. The patients’ mean preoperative prostatic volume was 56.7 mL. Antiplatelet agents or anticoagulants, used in 16 patients (32 percent), were discontinued before the operation.

Transurethral WVTT was performed with perioperative antibiotic prophylaxis and under local anaesthesia alone. “We did not administer any sedation because patients might move during the operation, resulting in a high risk of water vapour leakage. Such leakage would lead to inadequate treatment,” the researchers explained.

After the procedure, a 14 -Fr Foley catheter was inserted, and a 1-week course of antibiotic treatment was prescribed. Patients were discharged with the urethral catheter and readmitted for a trial without catheter (TWOC) at approximately 1–2 weeks after surgery. Upon satisfactory completion of TWOC, follow-up was scheduled at 3 months postoperatively.

“The mean operation time was 25.1 minutes,” the researchers reported. “Mean pain scores for transrectal ultrasound probe insertion, transperineal local anaesthestic injection and transurethral WVTT were 2, 5 and 4, respectively.”

“Postoperatively, 49 patients [98 percent] were discharged on the same day with a urethral catheter,” they noted. “TWOC was successfully completed in 48 patients [96 percent] within 3 weeks postoperatively.”

Five patients (10 percent) had unplanned hospital readmission within 30 days after the procedure due to surgical complications (recurrent AROU, n=2 [4 percent]; haematuria, n=1 [2 percent]; postobstructive diuresis, n=1 [2 percent]; urinary tract infection with AROU, n=1 [2 percent]), all of whom were uneventfully discharged without further readmission.

Significant improvements in symptoms and quality of life (QoL) were observed at 3 months after the procedure. Mean differences from baseline were -41 mL for postvoid residual urine (p=0.04), +6.6 mL/s for maximal urinary flow rate (p<0.001), -10.9 for International Prostate Symptom Score (p<0.001), and -2.2 for QoL score (p<0.001). While three patients (6 percent) reported new-onset erectile dysfunction, this was temporary and resolved within 6 months postoperatively without requiring medication.

“Our results demonstrated clinically significant outcomes comparable to other treatments for BPH,” the researchers noted. “Considering its minimally invasive nature, transurethral WVTT could revolutionize future management of BPH.”

In addition to a short learning curve of completing 10 cases under supervision, transurethral WVTT has the advantages of shorter mean operation time as well as lower incidence of bleeding, urgency, urge incontinence, and ejaculatory dysfunction compared with gold-standard transurethral resection of prostate, the researchers added. [Eur Urol 2009;56:798-809; J Endourol 2021;35:409-416]