Management of Urinary Retention Following Water Vapor Thermal Therapy
Urinary retention caused by water vapor thermal therapy is treatable with high success rates of 70-93% through appropriate management strategies. 1, 2, 3
Understanding Water Vapor Thermal Therapy and Retention
Water vapor thermal therapy (Rezūm) is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses convectively delivered thermal energy to ablate obstructive prostatic tissue. While effective for BPH symptoms, post-procedure urinary retention is a recognized complication that requires specific management.
Incidence and Mechanism
- Urinary retention occurs due to temporary prostatic edema and tissue sloughing following the thermal ablation
- Patients may require catheterization for a period following the procedure
- In the CoreTherm study (similar thermal therapy), catheterization was required for 14 days compared to 3 days with TURP 4
Treatment Algorithm for Post-Procedure Retention
1. Initial Management
- Planned catheterization period: Most patients require catheterization for approximately 28-31 days (median) following water vapor thermal therapy 1, 2, 3
- First trial without catheter (TWOC): Should be attempted after the initial catheterization period
2. For Patients Who Fail Initial TWOC
- Multiple TWOC attempts: Studies show an average of 1.6 TWOCs needed before successful voiding 1
- Extended catheterization: May be required for up to 65 days in some cases 1
- Alpha-blocker therapy: Consider adding or continuing during the catheterization period to relax prostatic smooth muscle
3. Success Rates and Timeline
- Short-term success: 70.3% of catheter-dependent patients become catheter-free at a median of 26 days (range 4-65) 1
- Medium-term success: 78.6% of patients void spontaneously after a median of 31 days 2
- Long-term success: 93.5% remain catheter-independent at 3 months and 91% at 12 months 2, 3
Factors Affecting Recovery from Retention
Studies have found no significant predictors of successful treatment outcomes among:
- Age
- Prostate volume
- Number of water vapor injections
- Presence of median lobe
- Duration of catheter dependency
- ASA score 1, 2
Special Considerations
High-Risk Patients
- Water vapor thermal therapy has shown effectiveness even in multimorbid patients (ASA III-IV) with catheter dependency who are considered unfit for surgery 2
- Success rates remain high (78.6%) even in this challenging population 2
Medication Management
- 69% of patients who become catheter-free can discontinue BPH medications 1
- Consider continuing alpha-blockers during the recovery period to facilitate voiding
Potential Complications During Recovery
Adverse events are typically mild and transient:
Long-Term Outcomes
For patients who successfully overcome post-procedure retention:
- Durable improvements in symptoms are maintained for up to 5 years
- Surgical retreatment rates range from 4.4% to 7.5% at 5 years 5
- Most patients maintain catheter independence once achieved (91-93.5% at 12 months) 2
Conclusion
Post-water vapor thermal therapy urinary retention is highly treatable with appropriate catheterization management and patience. The majority of patients (70-93%) will successfully void spontaneously within 1-2 months following treatment, with high rates of maintained catheter independence at long-term follow-up.