256 A Novel Prostatic Block for Minimally Invasive Treatment for BPH

Rezūm System radio frequency water vapor thermal therapy has emerged as an effective long term therapy in patients with lower urinary tract dysfunction (LUTs) secondary to benign prostatic hyperplasia (BPH). It is ideal for patients desiring a minimally invasive therapeutic option for their LUTs symptoms. A significant drawback from the procedure is the incidence of short term dysuria, hematuria and exacerbation of LUTs following the procedure. Therefore there is a need for an improved prostatic block to decrease the incidence of dysuria and LUTS following the procedure. We sought to evaluate our prostatic block in our cohort of patients receiving Rezum therapy, in improving short term exacerbation of LUTs. We reviewed 93 patients who underwent Rezum water vapor thermal therapy for BPH in a single surgeon retrospective study. All patients underwent a prostatic block, patient reported outcomes and complication rates were reviewed. Patients were selected to receive the therapy if prostate size was less than <110 grams, IPPS score >15, and a desire for a minimally invasive LUTs treatment. Patients were given a post op course of antibiotics and instructed to take Tylenol or NSAIDS as needed. Post-procedure patients were sent home with a foley catheter for 48 hours. Patients were given a prostatic block consisting of 5 cc of 0.5% Lidocaine and 5cc of 0.5% Bupivicaine. The patients received transrectal ultrasound guided 2 cc injections, 2 cc by the bladder neck and sphincter, 2cc midline by the prostate and seminal vesicle junction, 2 cc by each prostatic capsule, and 2 cc by the prostatic midline septum.