ABSTRACT
BACKGROUND: Rezum™ 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 Rezum™ 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.
Subject(s)
Prostatic Diseases , Prostatic Hyperplasia , Male , Humans , Anesthetics, Local , Outpatients , Feasibility Studies , Pain , Anesthesia, Local , Prostatic Diseases/complications , Prostatic Hyperplasia/surgeryABSTRACT
Focal therapy is a novel treatment option in localised prostate cancer with or without a visible lesion on MRI. Treatment for low to intermediate risk prostate cancer with focal therapy has demonstrated good short to medium term outcomes with fewer undesirable genitourinary side effects. This has made focal therapy more appealing to men who find the implications of radical treatment unacceptable or are unable to tolerate active surveillance. In this paper we review the literature for treatment options in prostate cancer recurrence post focal therapy. We also cover the different definitions of failure agreed upon in previous consensus meetings, as well as their implications on future management focal therapy patients
La terapia focal es una opción nueva de tratamiento en cáncer de próstata localizado con o sin lesión visible en la RMN. El tratamiento con terapia focal para el cáncer de próstata de riesgo bajo e intermedio ha demostrado buenos resultados a corto y medio plazo don menos efectos secundarios genitourinarios indeseables. Esto ha hecho la terapia focal más atractiva para varones que encuentran inaceptables las implicaciones del tratamiento radical o no son capaces de tolerar la vigilancia activa. En este artículo revisamos la literatura sobre las opciones de tratamiento en cáncer de próstata recurrente después de terapia focal. También cubrimos las diferentes definiciones de fracaso salidas del acuerdo en reuniones de consenso previas, así como sus implicaciones en el manejo futuro de pacientes de terapia focal
Subject(s)
Humans , Male , Prostatic Neoplasms/therapy , Prostatic Neoplasms , Prostatectomy/methods , Salvage Therapy/instrumentation , Salvage Therapy/methods , Salvage Therapy , Brachytherapy/instrumentation , Brachytherapy/methods , Radiotherapy/methods , Prostatic Neoplasms/radiotherapy , Homeopathic Therapeutic Approaches , Cryotherapy/methodsABSTRACT
Focal therapy is a novel treatment option in localised prostate cancer with or without a visible lesion on MRI. Treatment for low to intermediate risk prostate cancer with focal therapy has demonstrated good short to medium term outcomes with fewer undesirable genitourinary side effects. This has made focal therapy more appealing to men who find the implications of radical treatment unacceptable or are unable to tolerate active surveillance. In this paper we review the literature for treatment options in prostate cancer recurrence post focal therapy. We also cover the different definitions of failure agreed upon in previous consensus meetings, as well as their implications on future management focal therapy patients.
