Vapor injection under local anesthesia treatment of Benign prostatic hypertrophy (BPH)

• You can walk, but go gradually by alternating periods of activity of 15-30 minutes with rest periods.
• Avoid lifting heavy objects (more than 10 kg) for ONE week.
• Avoid intense exercise or physical activity for ONE week.
• Avoid having sexual activities for ONE week.
• Drink plenty of water, to allow small clots to drain well from the bladder and to have clear urine; about 8 ounces every 2 hours during the day and stop 2-3 hours before bedtime.
• The catheter is usually removed after approximately 7 days at the clinic or at the CLSC.
• A follow-up appointment is planned after 2 months, with an ultrasound of the bladder.

The vapor injection under local anesthesia is a treatment that uses radiofrequency to generate "wet thermal energy” in the form of water vapour, and inject it into different areas of the prostate in short sequences. In other words, the water vapour is injected into the prostate tissue that blocks the urinary flow of the bladder. This vapour is immediately reconstituted in water, releasing the energy stored in the cell membrane. Thus this technic gently and immediately causes cell damage, followed by cell death. Over time, your body will absorb treated tissue with its natural healing response. The volume of the prostate can then be reduced to 40%, in 3 to 6 months.

The vapor injection under local anesthesia vs MTOPS study of Gupta & al. in the Journal of Urology in 2018 demonstrated identical, if not better, results than medical treatment.

Goal:  They compared the single steam thermal therapy procedure with combined daily medical therapy (Doxazosin and Finasteride) in men with benign prostatic hyperplasia.

Population:  They evaluated the long-term outcome of treatment of lower urinary tract symptoms due to benign prostatic hyperplasia of more than 1,000 patients over a 3-year period. Patients were moderately or severely symptomatic (IPSS greater than 13) and the volume of their prostate was moderate to large (30-80 g).

Results:  The improvement in symptoms was greater than that seen with Doxazonine alone or Finasteride alone, but similar to that of combination drugs. A single steam thermal therapy procedure resulted in an effective and lasting improvement of symptoms with observed rates of clinical progression, lower than those of long-term daily use of the medication.

The improvement will gradual. It will be noticeable after two weeks but more so between 3 to 6 months after the intervention. After 3 months, the medication may be stopped.

Clinical studies demonstrate sustained improvement in symptoms up to 4 years. Additional studies are underway to determine the long-term outcome of patients.

Vapor injection under local anesthesia is a treatment for BPH is in one appointment. This intervention is performed in a minor surgery room in one of the Marois Clinics. The vapor injection under local anesthesia can be practiced under oral sedation and under local anesthesia (prostatic block). This treatment does not require general anesthesia. Dr. Marois will discuss pain management options with you, to manage your comfort during the procedure. The vapor injection under local anesthesia intervention is more uncomfortable than painful. The patient is installed on his back with the legs placed in stirrups. Sterile fields are placed. Anesthetic gel is first introduced into the urethra, followed by the vapor injection to the level of the prostate. Several injections of steam are then performed in each side of the prostate as well as in an intravesical lobe (middle lobe), if present. Everything is directed under direct vision with a camera. A urinary catheter is left in place for a few days.

This treatment has been shown to reduce urinary symptoms in many men with prostate hypertrophy (BPH). As a minimally invasive procedure, it has shown fewer side effects than those usually associated with surgical treatments, but as with any interventional procedure, some of the following side effects may occur temporarily:

• Painful urination
• Blood in the urine (hematuria)
• Blood in sperm (hemospermia)
• Frequent urination
• Inability to urinate or empty the bladder completely
• Need for short-term catheterization (urinary catheter)

Most of these adverse events disappear within 3 weeks of the procedure, but some of these effects may be prolonged. Please discuss with Dr. Marois ways to potentially reduce the effects of these risks.
Some of the following options may help relieve discomfort during the short-term healing process:

• Take a mild pain medication, such as Tylenol
• Take a warm bath or sit on a hot pad
• Eliminate caffeine, chocolate and alcohol temporarily from the diet