Patients with frailty, benign prostatic hyperplasia and indwelling bladder catheter: What are the 1-year outcomes after Rezūm therapy?

Background: Rezūm therapy, a minimally invasive surgical procedure for benign prostatic hyperplasia (BPH), was very recently developed. Its characteristics and safety profile render its use in patients with multiple comorbidities attractive. In this study, we evaluated the outcomes of Rezūm therapy in patients with frailty, BPH, and an indwelling catheter. Methods: This single-center prospective study involved consecutive patients with frailty who underwent Rezūm therapy from June 2022 to December 2023. Patients with a prostate volume of 30-150 cm3, indwelling bladder catheter for ≥6 months, and diagnosis of frailty were included. Frailty was defined as the concomitant presence of a Clinical Frailty Score of ≥4, Charlson Comorbidity Index of ≥3, and Modified Frailty Index of ≥2. The primary end point was successful removal of the catheter and continued catheter independence 12 months after treatment. The International Prostate Symptom Score, maximum urinary flow rate, and post-void residual volume were evaluated 3, 6, and 12 months after the procedure. Adverse events were monitored throughout the study. Results: Seventy patients were included: catheter removal was successful in 66 of these patients (94%), all of whom completed 1 year of follow-up without recatheterization. Statistically significant (p < 0.05) improvement was observed in the International Prostate Symptom Score, maximum urinary flow rate, and post-void residual volume during follow-up. No intraprocedural complications occurred. At 30 days, 4 of the 66 patients (6%) experienced postprocedural complications of Clavien-Dindo grades II (n = 2) and IIIa (n = 1). Conclusions: Rezūm therapy was effectively and safely performed in patients with frailty, BPH, and an indwelling catheter. Further large comparative studies are needed.