Das Rezūm-System in der Behandlung der Blasenentleerungsstörung auf dem Boden einer gutartigen Prostatavergrößerung (BPO)

Zusammenfassung

Der klassische Therapiealgorithmus zur Behandlung des benignen Prostatasyndroms (BPS) beinhaltet bei Versagen der medikamentösen Therapie einen chirurgischen Ansatz. Neue minimalinvasive Therapien (MIT) bieten das Potenzial für eine schnelle Symptomlinderung bei gleichzeitiger Reduzierung der mit den invasiven Verfahren assoziierten perioperativen Morbidität. Die konvektive interstitielle Radiofrequenz-generierte Wasserdampf-Thermoablation der Prostata mit dem Rezūm^®-System ist ein neuartiges MIT zur Behandlung von Männern mit moderaten bis schweren LUTS. Es ermöglicht eine schnelle und dauerhafte Linderung von Speicher- und Entleerungs-LUTS, das Erhalten unzerstörter Sexualfunktion (in Bezug auf sowohl Erektion als auch Ejakulation) und die Verbesserung der Lebensqualität. Das Verfahren bietet sich für die Behandlung eines breiten Spektrums von Prostatadrüsenmorphologien einschließlich intravesikaler Prostataprotrusion, Mittellappen- oder Blasenhalselevation durch zentrale Hyperplasie. Das Rezūm-Verfahren kann auch als Erstlinientherapie zur Krankheitsprogressionsvorbeugung als Alternative zur medikamentösen Langzeit-Polytherapie bei selektionierten Patienten angesetzt werden, um mögliche medikamentenassoziierte Nebenwirkungen zu vermeiden. Dieser Übersichtsartikel befasst sich mit der Beschreibung dieser neuen Technologie und ihrer klinischen Anwendung sowie mit der aktuellen Evidenz, die die Effektivität, die Sicherheit und die Perspektive des Rezūm-Verfahrens bis zum jetzigen Zeitpunkt unterstützt.

Abstract

The classical algorithm of the management of male lower urinary tract symptoms (LUTSs) due to benign prostatic hyperplasia (BPH) includes a surgical approach in case pharmacological therapy has failed. Emerging minimally-invasive treatments (MITs) offer potential for rapid symptomatic relief, reducing the morbidity of invasive BPH surgery. Convective interstitial radiofrequency water vapour thermal ablation of the prostate with the Rezūm^® system is a novel MIT for the treatment of bothersome moderate-to-severe lower urinary tract symptoms associated with BPH. It provides early effective and durable relief of storage and voiding LUTSs, preserving both erectile and ejaculatory function and improving quality of life. The procedure allows the treatment of a wide spectrum of prostate gland morphologies including intravesical prostatic protrusion, median lobe protrusion or elevated bladder neck. In selected patients, this procedure can also be offered for first-line treatment to prevent symptom progression and may thus be used as an alternative to long-term pharmaceutical treatment in order to avoid potential side-effects of drugs. This review describes this new technology and its clinical application and presents the current clinical evidence that supports the efficacy, safety and prospects of the Rezūm procedure to date.

Schlüsselwörter

Prostata - Benignes Prostatasyndrom - Symptome des unteren Harntrakts - konvektive RF-Wärmetherapie - minimalinvasive Verfahren

Keywords

prostate - benign prostatic hyperplasia - lower urinary tract symptoms - convective RF thermal therapy - minimally-invasive procedure

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