Newly developed equipment and methods in the treatment of BPH: analysis of present status

Benign prostatic hyperplasia (BPH) is the most common disease among the aged male population. A variety of symptoms are mainly caused by obstructive changes at the prostatic urethra. Transurethral resection (TURP) has been the gold standard of treatment, but new equipment and methods such as TUMT, HIFU, TUNA, and laser prostatectomy have been developed and are being tested for clinical application. Our experience with new equipment and methods show that their effectiveness has yet to be conclusively evaluated by objective parameters, while subjective improvements have been seen with less invasive treatments such as TUMT, HIFU and TUNA. Laser prostatectomy confirmed its advantages in hemostasis but comparison of each treatment is difficult because of different pathological changes created by different energy sources shown by MRI. Further studies are required to examine the new equipment and methods and for identification of the treatment of choice for BPH.

A radiofrequency method of thermal tissue ablation for benign prostatic hyperplasia

OBJECTIVES

To evaluate the safety, feasibility, and efficacy of transurethral ablative prostatectomy (TURAPY), a radiofrequency method of thermal tissue ablation of benign prostatic hyperplasia (BPH).

METHODS

Twenty men, ages 55 to 81 years (mean, 67), with symptomatic BPH and with peak flow rate 12 mL/s or less, were treated with the TURAPY device (Direx Medical Systems). A 2 cm long heating element and 2 thermoprobes (for simultaneous prostatic temperature monitoring) are mounted on a Foley-like catheter and used for TURAPY treatment administration. This TURAPY catheter was modified by placing an extra set of thermoprobes in the sphincter region to allow sphincteric temperature monitoring. The treatment was administered at a maximum temperature of 70 degrees to 75 degrees C for 1 hour under local anesthesia as a day case.

RESULTS

All 20 patients completed the treatment. The maximum recorded rectal temperature was 39.5 degrees C. The maximum sphincter temperature was not allowed to exceed 42 degrees C. The post-treatment morbidity included dysuria and minor urethral bleeding in 12 patients. Three patients developed urinary infection requiring antibiotic treatment. All 20 patients were followed up 3 months after treatment. The mean International Prostate Symptom Score (IPSS) improved from 19.4 to 6.2 (68%), the mean peak flow rate increased from 7.9 to 12.9 mL/s (63%), and the mean postvoid residue decreased from 222 to 81 mL (64%). Overall, 80% of patients exhibited at least a 50% improvement in either the IPSS or the peak flow rate. There was a mean reduction in prostatic volume measured by transrectal ultrasound of 14 mL (29% reduction). The subjective and objective improvements, in 8 patients followed up 6 months after treatment, have been maintained. There was extensive coagulative heat necrosis of periurethral tissue with sparing of subcapsular tissue in prostate biopsy specimens taken from 1 patient 5 days after treatment. There was endoscopic and sonographic evidence of canalization of the obstructed prostatic urethra 3 months after treatment.

CONCLUSIONS

Treatment with the TURAPY device was found to be safe, feasible, and effective in improving both subjective and objective measurements of benign prostatic obstruction in this pilot study on 20 patients.

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)