Results of deep prostatic hyperthermia applied with Thermex II in 525 benign prostatic hyperplasias

Integrality of benign prostatic hyperplasia tissues after transurethral thermotherapy evidenced by transmittance fourier transform infrared spectroscopy combined with thermal analyzer

Transmittance Fourier transform infrared microspectroscopy combined with differential scanning calorimetry was used to simulate the clinically transurethral thermotherapy of benign prostatic hyperplasia (BPH) by in vitro isothermal determination. The simulative study to the thermotherapy of epithelium or stroma in BPH tissue was performed at 47 degrees C for 3 h, like clinical therapy. Whether thermal treatment can induce changes in the secondary structure of epithelium or stroma in BPH tissue was investigated. The results indicate that the epithelium and stroma in BPH tissue had different protein secondary structures, due to the different compositions of the epithelium and stroma. No significant change was evidenced in secondary structure for each sample either before or after isothermal study, suggesting the integrality and safety of BPH thermotherapy in a 47 degrees C for 3 h treatment course.

Transurethral needle ablation of the prostate: a urodynamic based study with 2-year followup

PURPOSE

We evaluated the efficacy of transurethral needle ablation of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia (BPH). This study was urodynamic based with 2-year followup to determine whether transurethral needle ablation of the prostate could reduce bladder outlet obstruction and, if so, whether the effect was durable.

MATERIALS AND METHODS

A total of 47 patients with symptomatic BPH underwent transurethral needle ablation of the prostate under local anesthesia and intravenous sedation. All patients were evaluated subjectively using the American Urological Association symptom index and the quality of life score. Patients were evaluated objectively with uroflowmetry, post-void residual volume and pressure-flow studies. All patients underwent subjective and objective evaluation before treatment. Followup was conducted at 1, 3, 6, 12 and 24 months after treatment. Short and long-term complications were assessed.

RESULTS

At 6-month followup there was 71% improvement in mean cases (22.4 to 6.6, 42 patients symptom index, p < 0.05), and 66% improvement in mean quality of life score (4.6 to 1.56, 42 patients, p < 0.05). Maximum flow rate, post-void residual volume and detrusor pressure at maximum flow rate also showed statistically significant improvements throughout the study. At 12-month followup there was a 55% increase in maximum flow rate (6.6 to 10.23 ml. per second, 29 patients, p < 0.05). A 37% reduction in mean detrusor pressure at maximum flow rate (92.4 cm. to 58 cm. water, 31 patients, p < 0.05) was recorded at 24-month followup, thus indicating that transurethral needle ablation of the prostate can lower bladder pressure-significantly. Post-void residual volume decreased from a pretreatment mean of 76.1 ml. to a mean of 36.9 ml. (31 patients, p < 0.05) at 24 months. Short-term complications (3 months) included transient posttreatment urinary retention in 8 patients (17%), duration 1 to 9 days, mild to moderate transient frequency dysuria all patients which resolved in more than 90% by 5 weeks and epididymitis in 1. A patient questionnaire was used to evaluate changes in sexual function and there were no reports of disturbances in erectile function or retrograde ejaculation. There were no long-term complications. However, 6 patients (12.7%) had persistent bothersome symptoms during the followup period and underwent transurethral prostate resection. Further analysis of this subset of patients with respect to pretreatment evaluation and transurethral needle ablation procedure did not reveal significant differences between them and patients with successful outcomes.

CONCLUSIONS

Transurethral prostate resection is a safe and effective technique for treating lower urinary tract symptoms related to benign prostatic hyperplasia. The technique can be performed in the office as an outpatient, or as a same day surgical procedure, using topical anesthesia with intravenous sedation, if necessary. In the majority of patients subjective and objective improvements were sustained for the duration of this study, which included 2-year followup with pressure-flow studies.

Transurethral thermotherapy in the management of benign prostatic hyperplasia

Transurethral radiofrequency thermotherapy for symptomatic benign prostatic hyperplasia was performed in 50 selected patients, using the THERMEX II device. High surgical risk patients were included, among them 13 previously catheterized ones, because of unresolved retention for more than 6 months. The treatment consisted of a three-hour single session at 47 degrees C. Follow-up studies were carried out at 1, 3, 6 and 12 months using Madsen score, maximum flow rate, residual urine volume determinations and prostate bulk measurement by transrectal ultrasound. Subjective and objective improvement (of more than two parameters) was noticed in 62% of the patients. Prostatic volume did not change. In the retention group 54% of the patients remained free of catheter. Postoperative histology in 8 cases that failed to respond, revealed focal haemorrhagic and necrotic changes in periurethral glandular tissue. This is a promising method for selected high risk patients that achieves reasonable but not comparable results to TURP and requires further investigation in larger patient groups with BPH.

Turapy--transurethral ablation prostatectomy by high temperature radiofrequency--preliminary results of a multicenter study

Thermal treatment of BPH has been introduced several years ago as an alternative treatment modality for patients suffering from symptomatic BPH. The initial temperatures ranged from 44.5 to 48 degrees C. With these temperatures, about 60-70% of the patients showed significant improvement of their subjective, mainly irritative symptoms with only mild changes in their obstructive parameters. In order to improve the therapeutic effects, increase in energy delivered allowing higher temperatures in the order to 70-100 degrees C was investigated regarding the feasibility, tolerance, pathological lesions and clinical effectiveness. A new radiofrequency technique, TURAPY--TransURethral Ablation Prostatectomy, an outpatient ablative BPH treatment has been introduced recently. The treatment is applied transurethrally with a helicoidal antenna without any cooling system. Temperature delivery in the order of medium 75 degrees C was applied during a medium time of 45 minutes. An ongoing multicenter study included 38 patients. 15 patients were operated by retropubic prostatectomy after 6-30 days, for a histopathology study and 23 eligible patients were entered in a clinical study and analyzed to determine the efficacy of the TURAPY treatment. The tolerance was excellent and although patients experienced initial heating sensation at the onset of treatment, as the temperature rose to 40-50 degrees C (as with previous modalities of thermotherapy), they did not experience further pain and the procedure was never stopped. Urinary retention was observed in about 80% of the patients, due to the extensive tissular destruction. These patients had suprapubic catheter inserted one day to a maximum of one week (medium 3 days).(ABSTRACT TRUNCATED AT 250 WORDS)