後腹腔積氣及後腹腔積液：來自外院診所的Rezūm水蒸氣治療的罕見併發症

黃國倫¹、吳俊賢^1、2、林嘉祥^1、2、董牧喬¹

¹義大醫療財團法人義大醫院 泌尿科；²義守大學 醫學系

Pneumoretroperitoneum and Retroperitoneal Fluid Collection: A Rare Complication of Rezūm Water Vapor Therapy Referred from a Local Clinic

Allen, Guo-Lun Huang¹, Chun-Hsien Wu^1,2, Victor C. Lin^1,2, Mu-Chiao Tung¹

Department of Urology¹, E-Da Hospital, Kaohsiung, Taiwan;

School of Medicine, College of Medicine², I-Shou University, Kaohsiung, Taiwan

Introduction: Rezūm water vapor therapy is a novel minimally invasive surgical treatments (MISTs) widely used for managing benign prostatic hyperplasia (BPH). With its short operation time and less anesthesia required, Rezūm therapy is generally well-tolerated by patients. The most common complications following Rezūm therapy include dysuria, acute urinary retention (AUR), and urinary tract infection (UTI). However, pneumoretroperitoneum and retroperitoneal fluid collection could be extremely rare complications, which can lead to significant morbidity if not promptly identified and managed. In this case report, we present an unusual instance of pneumoretroperitoneum and retroperitoneal fluid collection following Rezūm therapy.

Case report: A 67-year-old male had medical history of hypertension, Parkinsonism, and BPH complicated with refractory lower urinary tract symptoms. His pre-operative International Prostate Symptom Score (IPSS) was 12, consisted of an emptying score 7 and storage score 5. No nocturia was mentioned. Pre-operational prostate specific antigen (PSA) level was 6.5 ng/ml. Transrectal ultrasound of prostate indicated a total prostate volume about 50 ml with significant intravesical prostatic protrusion. Digital rectal examination did not reveal any palpable nodules. Despite the elevated PSA level, Rezūm therapy was performed on 2024/03/18 at a local clinic by a urologist. After the Rezūm therapy, the patient developed acute lower abdominal pain, AUR, and gross hematuria. Attempts to insert a Foley catheter were unsuccessful, likely due to prostate swelling derived from the Rezūm therapy. The patient was subsequently referred to our emergency department for further evaluation. On physical examination, the patient exhibited bladder fullness and suprapubic tenderness. Bedside bladder ultrasonography demonstrated significant retention of urine with minimal amount of blood clots. A computed tomography (CT) scan of the abdomen and pelvis revealed a swollen prostate with size nearly doubled (95ml). In addition, there was gas accumulation surrounding the bladder within the pelvic cavity, along with fluid accumulation in the bilateral subphrenic region, retroperitoneum, and pelvis, suggestive of an retroperitoneal fluid collection (Fig. 1). Treated as an urethral injury, beside suprapubic cystostomy was performed for urinary diversion first. Later, the patient underwent cystoscopy at the operation room, which facilitated successful Foley catheter placement. Cystostomy was removed post-operatively. Antibiotic prophylaxis with Ceftriaxone was given for three days in worry of retroperitoneal abscess occurrence. Luckily, no fever had developed. The Foley catheter was removed on post-operative day 7. A subsequent uroflowmetry study recorded an obstructive flow pattern (maximum flow rate of 4.2 mL/sec) and significant post-void residual urine volume of 128 ml. Serial follow-up of total prostate volume was conducted (Fig. 2).