ABSTRACT
Author of the study: Rezum is one of the most promising minimally invasive technologies for the treatment of BPH. During Covid pandemic era we used this technique extending the indication even in patients carryng urinary catheter or in patients with prostatic adenoma volume higher than 80 ml. In this short communication we report the preliminary results of our experience. Material(s) and Method(s): From January 2019 to September 2021 92 patients underwent a Rezum treatment. Of these patients 51 (55%) carrying catheter for urinary retention secondary to BPH. Inclusion criteria was: age >18 yo, catheterization time >3 months, prostate adenoma volume >30 cc. A 6 months follow up was offered to each patient including uroflometry and PSA. Result(s): Mean age was 75 yo (62-84), mean iPSA 3,7 ng/ml (1,9-5,8), mean adenoma volume 92 cc(65-270). Mean catheterization time before treatment 7,8 months (3-14). Mean operative time (12,5 min (11-14). All patients were discharged 4 hours after the treatment. Catheter removal was performed after 4/6 weeks. 48 (94%) patients obtained a spontaneous micturition. Mean Qmax at 6 months 12,5 cc/ sec, mean Post-void residual 120 cc. In 3 patients we observed post operative IVU treated with antibiotics. 21 (44%) patients continue alpha-litic therapy after Rezum treatment. In 2 patients it was necessary performing a disobstructive surgery. Conclusion(s): Rezum may represent a possible minimally invasive therapeutic strategy for BPH complicated by urinary chronic retention whenever other procedures aren't feasible. Despite the technical card indications, we successfully treated even prostate adenoma volumes higher than 80 ml. In some cases oral therapy was still necessary after the procedure. Our preliminary results are encouraging to continue to performing this procedure in these patients but further studies with longer follow up are needed Copyright © 2022 European Association of Urology. Published by Elsevier B.V.
ABSTRACT
Introduction & Objectives: COVID-19 pandemic has significantly affected urological activity worldwide. The enhancement of hygienic measures including distancing, restricted access to the ward, reduction in the number of hospitalized patients and use of PPE has potentially reduced the risk of COVID-19 infections. These strategies could simultaneously reduce the risk of nosocomial infections during hospitalization. The aim of our study is to evaluate the effectiveness of prevention measures against COVID-19 in reducing the incidence of infectious complications during hospitalization. Materials & Methods: In a retrospective observational study, we collecteddata of all patients admitted to two Urological centers: “Santa Croce and Carle” in Cuneo and “Policlinico Paolo Giaccone” in Palermo. We compared the period from February to May 2019 to the corresponding months of 2020. After collecting patients clinical characteristics (age, comorbidities, etc.), we evaluated the days of hospitalization, the number and type of surgical interventions (major, endoscopic - divided into upper and lower tract - and others), the onset of fever or new COVID-19 cases during hospitalization, the number of blood and urine cultures performed and the type of pathogen identified. Data were compared with media-standard deviation (SD) and with unpaired T-test. A value of p <0.05 was considered significant. Discrete data were analysed with contingency analysis. A Chi2 <0.05 was considered significant. Results: A total of 985 patients were included. Comparing 2019 with 2020, there was a statistically significant reduction in the incidence of postoperative fever considering all hospitalized patients (p<0.001). There was a statistically significant reduction in post-operative fever incidence after major surgery(p<0.04) and lower tract endoscopic procedures (p<0.02). There were no statistically significant differences in uppertract endoscopic procedures (p<0.99), neither in other minor surgical procedures (p<0.6). The rate of patients with positive blood culture compared to 2019 has decreased significantly (p<0.007), and although statistical significance was not reached, the same trend is observed in the number of patients with positive urine culture (p<0.08). Conclusions: The strong prevention measures implemented during COVID-19 pandemic have led to a general significant decrease in infectious complications acquired during hospitalization. This is more evident in patients undergoing major surgical procedures that require longer hospital stay. The use of some of widely used preventive measures against COVID-19 should therefore be maintained in the hospital environment even at the end of the pandemic situation(e.g. frequent hand washing,reduced access to hospital wards anddistancing between patients in hospital rooms and common spaces).