Failed Trial Without Catheter Post Rezūm in Non-Catheter Dependent Patients: Risk Factors From the Canadian Rezūm Registry.

INTRODUCTION

Rezūm has become an increasingly popular surgical approach for treating bladder outlet obstruction. Despite the practice of routinely placing a Foley catheter, successful TWOC (Trial Without Catheter) remains variable. This study seeks to identify the TWOC failure incidence and risk factors to inform clinical decisions and enhance patient counseling.

METHODS

We conducted a retrospective review of non-catheter dependent patients who underwent Rezūm therapy between April 2019 and June 2023 in two high-volume Canadian centers. All patients received a urinary catheter post-treatment. International Prostate Symptom Score (IPSS), QoL, Qmax, and PVR were evaluated. Risk factors for TWOC failure were determined through logistic regression.

RESULTS

Out of 406 patients, 99 patients (24.4%) failed TWOC on the first attempt. Median time to TWOC was 7 days (range 3-30 days). Successful and failure groups had no significant difference in terms of average catheterization time, baseline prostate volume, PVR, or total number of injections per prostate volume ratio. A higher rate of UTIs was observed in the TWOC failure group (10.6% vs. 2.6%, p = 0.003). During the 12-month follow-up period, 12 patients developed episodes of urinary retention following Rezūm therapy. Baseline PVR was not a risk factor for failed TWOC in our cohort (p = 0.95). Higher IPSS was a predictor for TWOC failure (OR 1.04 95% CI: 1.01-1.08).

CONCLUSIONS

About one in four patients failed the first TWOC after Rezūm therapy. High baseline IPSS was identified as the only risk factor for TWOC failure in our cohort. Despite this, overall urinary symptoms improved in all patients.