Transurethral water vapor therapy (Rezūm) for acute urinary retention with obstructive uropathy: a prospective cohort...

This prospective cohort study evaluates the safety and efficacy of transurethral water vapor therapy (Rezūm) in men with acute urinary retention (AUR) complicated by obstructive uropathy (acute renal impairment).

Obstructive uropathy was defined per 2012 Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury (AKI) criteria. Rezūm was performed as an ambulatory procedure under local anesthesia. The primary outcome was the proportion of catheter-free patients at 3 and 12 months with stable renal function (i.e. serum creatinine not exceeding +0.3 mg/dL or 1.5 times baseline).

Twenty-three consecutive patients were recruited (August 2023-February 2024). Median age was 71 years (interquartile range [IQR]: 67-80) and mean ± standard deviation of prostate size was 57.9 ± 13.8 mL. At 3- and 12-month follow-up, 96% (22/23) were catheter-free with stable renal function. Median time to successful trial without catheter (TWOC) was 36.5 days (IQR: 27.5-42.8 days). Prostate size decreased by 36.8% (P < 0.001) at 3 months. Thirty-day readmissions occurred in 13% (3/23), all Clavien-Dindo grade 1-2.

Rezūm shows promise as a safe and effective procedure in AUR with obstructive uropathy, providing durable catheter independence in high-risk patients. It expands minimally invasive surgical therapies (MISTs) indications, particularly as an ambulatory option under local anesthesia.