One-Year Outcomes of a UK Center Delivering Minimally Invasive Surgery for Bladder Outflow Obstruction Using Local Anesthetic Without Sedation in the Office Setting

Abstract

Background:

Minimally invasive surgical therapies (MISTs) for bladder outflow obstruction are now commonplace in many urological centers, often performed as day case procedures under general anesthetic or local anesthetic (LA) with sedation. Our center has adopted an outpatient clinic LA-only setting to deliver Rezum, Urolift, and iTind using prostatic block and LA gel. We present our 1-year outcomes to determine the feasibility of delivering MIST in this setting.

Methods:

We retrospectively audited outcomes, collecting data on patient demographics, pre- and postoperative symptom questionnaires, flowmetry tests, and visual analogue scores (VASs) during the procedure. We compared pre- and postoperative changes using a paired t test, using a p value of <0.05 as significant.

Results:

There were 81 procedures performed: 38 (46.9%) Rezum, 22 (27.2%) Urolift, and 21 (25.9%) iTind. The median age was 68 (interquartile range: 63–74). Preoperatively the mean International Prostate Symptom Score (IPSS) was 20.2 (±7), quality of life (QOL) score 4.6 (±1.4), Qmax 10.7 mL/s (±5.3), prostate serum antigen 2.5 (±3.1), and prostate size 48.8 mLs (±20.9). 70.4% of patients were on an α-blocker, and 44.4% on a 5-α-reductase inhibitors (ARI). The mean VAS was 4.3 (±2.8) out of 10. The total immediate postoperative complication rate was 11.1%, all less than Clavien–Dindo III. 91.4% attended the 3-month follow-up. Postoperatively the mean IPSS was 11.3 (±7.1) (44.1% reduction, p < 0.01), the QOL score 2.4 (±1.5) (47.8% reduction, p < 0.01), and the Qmax 13.1 mL/s (±5.5) (22.4% improvement, p < 0.01). Patients on an α-blocker had reduced to 34.6%, and 5ARIs to 13.6%.

Conclusion:

We demonstrate the feasibility of delivering MIST under LA alone, without sedation, and report significant improvements in symptom scores and flowmetry outcomes. Patients tolerate the treatment well without sedation and have a short stay for their procedure, enabling the service to be delivered in an outpatient clinic setting, improving inpatient waiting lists and resource allocation to outpatient setting. Further research is required for long-term outcomes, but early results are promising in driving a change in the delivery of MIST.