Authors (including presenting author) :
Lo KL, Mok A, Ko I, Kwok H, Ng T, Wong F, Wong J, Yuen S, Chan S, Li J, Tam M, Chan W, Teoh JYC, Chiu P, Yee CH, Chan CK, Ng CF
Affiliation :
(1)Division of Urology, Department of Surgery, New Territories East Cluster, (2)Division of Urology, Department of Surgery, The Chinese University of Hong Kong
Introduction :
Conventional surgical treatment of prostatic hyperplasia has its own limitations including peri-operative morbidity and long-term complication. It also requires general or spinal anesthesia inside operation theatre and hospitalization. With advancement in technology, transurethral water vapour thermal therapy of prostate can be performed under local anesthesia outside operation theatre which provides promising outcomes.
Objectives :
(1) To introduce a pilot same day discharge program of minimally invasive surgery for prostatic hyperplasia under local anesthesia; (2) To minimize hospital stay, surgery related complication and waiting time of surgery; (3) To maximize the utilization of operation theatre; (4) To improve the lower urinary tract symptoms and quality of life.
Methodology :
The water vapour thermal system contains a generator with a radiofrequency power supply to create water vapor and a disposable transurethral delivery device. Water vapor is injected into the targeted prostatic tissue using an 18-gauge needle. The released thermal energy will cause tissue necrosis and widen prostatic channel. The patient can be discharged with an indwelling urethral catheter on the same day after surgery and readmitted to Day Center for trial without catheter. They will have follow-up at 3 and 12 months after surgery.
Result & Outcome :
Between June 2020 and December 2022, more than 100 patients fulfilled the inclusion and exclusion criteria were recruited for this program. This surgery was performed under the local anesthesia. Patients with high anesthetic risk could also be benefited from this surgery. It was recently done in endoscopy center, sparing operation theatre for other surgeries requiring general or spinal anesthesia. With this, it greatly shortened the waiting time and hospitalization of prostatic hyperplasia surgery. We have reviewed and analyzed the first 50 cases. The mean age was 69.9 (64-75) years old. The mean pre-operative prostatic volume was 56.7 mL (SD = 24.6mL, range: 29.2 – 119.0mL). The mean operation time was 25.0 minutes (SD = 8.5 minutes, Range: 10 – 57 minutes). It was much shorter than the conventional surgical treatment. There were significant differences of pre-operative and 3-month post-operative parameters, including post-void residual urine (P = 0.038), maximal uroflow rate (P <0.001), symptom score (P <0.001) and quality of life assessment (P <0.001). As a result, it was supported with top-up funding under the Hospital Authority Medical Device Management Program (2022/23).
With the above promising outcomes, it is proven to be a safe and effective procedure to relieve the lower urinary tract symptoms. It can be performed as a day case procedure under local anesthesia, which can help to maximize the utilization of the operation theatre and hospital bed. We will further expand the service to treat more patients in the future.
