We began offering Rezūm under local anesthesia in the office in May; in our first 20 patients, catheter time averaged 2 days and recovery has been smoother than our OR pathway, which feels like a win for urinary tract health. For those doing minimally invasive BPH work outside the OR, how are you standardizing analgesia and peri-procedural antibiotics to keep it safe and consistent?
And > the OR, how are you standardizing analgesia and peri-procedural antibiotics to keep it safe and consistent? We standardized to a single-dose TMP-SMX DS 60–90 min pre-procedure if the urine culture’s negative within 14 days and stopped routine postop antibiotics; UTI calls dropped, and we use culture-directed coverage only for known colonization…
Moved office in May too and we’re also at about 2‑day catheters. We standardized to a buffered periprostatic 1% lidocaine block plus ibuprofen [redacted] and oxybutynin [redacted] an hour pre‑case; nitrous only if really anxious. On antibiotics, we follow “no routine prophylaxis” with a sterile UA and, @tessaG1978, reserve a single dose (we use 3 g fosfomycin) for prior UTI/catheter patients due to TMP‑SMX resistance locally.
Swapping our periprostatic block to 0.25% bupivacaine (about 5–[redacted] per lobe) with a small bicarbonate bump cut next‑day spasm calls and let us pull catheters at 24–36 h, @nathanC91; onset’s a touch slower than lido but it lasts through the evening.
Our early run mirrored your “2-day catheters”; adding a small IM ketorolac at check-in plus a ropivacaine periprostatic block with a touch of bicarb cut the spasm calls () and let us trial void at 24–36 h… Antibiotics-wise we follow AUA prophylaxis — cefazolin IV about 45 min pre-procedure after a negative pre-op culture, no post-op pills; beta-lactam allergy gets gentamicin — see https://www.auanet.org/guidelines/antimicrobial-prophylaxis; anyone seeing different UTI rates with this?
One thing that helped us was dropping routine prophylaxis: if UA/culture is clean and no indwelling catheter, we skip it; otherwise a single pre-procedure dose guided by the culture per AUA’s statement (https://www.auanet.org/guidelines-and-quality/guidelines/best-practice-statements/antimicrobial-prophylaxis). Paired with a brief lidocaine gel dwell, we maintained the “2-day” catheters without a UTI bump; caveat — we still cover poorly controlled diabetics.