A temporary intraurethral prostatic stent relieves prostatic obstruction following transurethral microwave thermotherapy

PURPOSE: The Spanner, a novel prostatic stent, was evaluated for safety, efficacy and patient tolerance when used to relieve prostatic obstruction following transurethral microwave thermotherapy. MATERIALS AND METHODS: Following transurethral microwave thermotherapy and routine post-procedure Foley catheterization at 1 of 9 clinical sites 186 patients meeting study criteria were randomized to receive a Spanner (100) or the standard of care (86). Baseline evaluations included post-void residual urine, uroflowmetry, International Prostate Symptom Score and International Prostate Symptom Score quality of life question. These evaluations were repeated at visits 1, 2, 4, 5 and 8 weeks after randomization (Spanner insertion) with the addition of the Spanner satisfaction questionnaire, ease of use assessment and adverse events recording. The Spanner was removed after 4 weeks, at which time the Spanner and standard of care groups underwent cystourethroscopy. RESULTS: At the 1 and 2-week visits the Spanner group showed significantly greater improvements from baseline in post-void residual urine, uroflowmetry and International Prostate Symptom Score compared to the standard of care group. The Spanner group experienced significantly greater improvements in quality of life at the 5 and 8-week visits. Patient satisfaction with the Spanner exceeded 86%. Cystourethroscopy findings in the Spanner and standard of care groups were comparable and adverse events associated with previous stents were rare. CONCLUSIONS: The Spanner is a safe, effective and well tolerated temporary stent for severe prostatic obstruction resulting from therapy induced edema after transurethral microwave thermotherapy. It may be a needed addition to the armamentarium for managing bladder outlet obstruction in a broad group of urological patients.     

Treatment of benign prostatic hyperplasia using transurethral microwave thermotherapy and dilatation with double-balloon catheter

PURPOSE: To improve the outcome of transurethral microwave thermotherapy (TUMT) for the treatment of benign prostatic hyperplasia, we combined TUMT and balloon dilatation (BD) with a double-balloon catheter and investigated its effects. PATIENTS AND METHODS: For a short-term trial, 40 patients were divided randomly into two groups: 20 patients received TUMT alone, and the other 20 received TUMT followed by BD. The degrees of symptoms were graded according to the International Prostate Symptom Score and Quality of Life score, and the peak urinary flow rate was measured before and 10 weeks after treatment. A historic control study of 527 patients was also performed to evaluate the long-term re-treatment rate: 98 of the patients received TUMT alone, and the other 429 patients received TUMT followed by BD. RESULTS: The symptom scores improved significantly in both groups. The peak uroflow rate was significantly increased in the group who received TUMT followed by BD (P < 0.01), whereas the change was not significant in the TUMT-alone group. Significant sustainability of long-term effects was more evident in patients receiving TUMT plus BD than in the TUMT-alone group, as judged by the higher proportion of BD-treated patients who required no further treatment during the 5-year study period in comparison with patients who received TUMT alone (66.3% v 28.6%, respectively; P < 0.001). CONCLUSIONS: Combined TUMT and BD achieves sufficient subjective and objective improvement and a sustainable long-term effect. We consider this combination technique to be useful for the treatment of prostatic hyperplasia.     

Prospective randomized comparison of high energy transurethral microwave thermotherapy versus alpha-blocker treatment of patients with benign prostatic hyperplasia

PURPOSE: We compare directly the efficacy and safety of targeted high energy transurethral microwave thermotherapy with alpha-blocker treatment for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: In this randomized prospective study 52 patients with symptomatic BPH received terazosin and 51 underwent high energy transurethral microwave therapy with topical anesthesia. Patient evaluation included determination of International Prostate Symptom Score (I-PSS), peak flow rate and quality of life score before transurethral microwave therapy or terazosin and periodically up to 6 months thereafter. RESULTS: At 2-week followup the terazosin group transiently exhibited significantly greater improvement than the transurethral microwave therapy group in mean values of all 3 primary efficacy parameters of I-PSS, peak flow rate and quality of life score. At 12 weeks and 6 months this pattern was reversed, and the transurethral microwave therapy group achieved significantly greater improvement than the terazosin group in mean I-PSS, peak flow rate and quality of life score. By 6 months 78.4, 64.7 and 84.3% of the transurethral microwave therapy group demonstrated a 50% or greater improvement in I-PSS, peak flow rate and quality of life score, respectively, compared with 32.7, 9.6 and 40.4% of the terazosin group, respectively. Nine patients in the terazosin group and 1 in the transurethral microwave therapy group withdrew from study because of side effects or lack of treatment efficacy. CONCLUSIONS: Terazosin afforded more rapid improvement in symptoms, voiding function and quality of life in BPH patients. High energy transurethral microwave therapy offered markedly superior clinical outcomes at 12 weeks to 6 months.     

Aspects on transurethral microwave thermotherapy of benign prostatic hyperplasia

The underlying principle behind new minimal invasive procedures, such as microwave thermotherapy, is to coagulate the prostatic adenomatous tissue by means of heat. This article describes the action of heat on tissue and identifies areas of concern during treatment. The extent of the necrosis during treatment is governed by two physical variables: the intraprostatic temperature and the duration of the heat exposure. The prostatic blood flow is a key factor for the outcome of microwave treatment because it acts as a coolant and may effectively sink the temperature in the treatment area. Blood flow can vary substantially between patients and may change significantly during treatment. By measuring the intraprostatic temperature and varying the microwave power accordingly, it is possible to compensate for the large variations in prostatic blood flow and obtain consistent treatment.     

A single session of transurethral microwave thermotherapy for benign prostatic hyperplasia]

A single session of transurethral microwave thermotherapy using Prostatron (Technomed International, France) was performed in 20 patients with benign prostatic hyperplasia, and the clinical efficacy of this modality was evaluated by analysing the subjective and objective responses following the treatment. 1,296 MHz microwaves are delivered to the prostate by an antenna placed in a 20 Fr urethral balloon catheter equipped with a cooling system for preservation of the urethral mucosa. The treatment was performed in a single session for an hour on an outpatient basis. The clinical efficacy was evaluated by a total score of subjective symptoms and objective findings including residual urine and average flow rate, 8 weeks after the treatment. Reduction of subjective symptom score was observed in 26 cases (86.7%), and that of objective findings in 21 (70%). When 25% or more decrease of the total score was defined as good, the overall good result including subjective and objective responses was seen in 24 cases (80%). During the treatment and follow-up period, no severe adverse effect was detected. In conclusion, a single session of thermotherapy by Prostatron is a safe and useful modality as a non-surgical treatment performed on an outpatient basis for benign prostatic hyperplasia.     

Transurethral microwave thermotherapy for benign prostatic hyperplasia

Transurethral resection of the prostate (TURP) remains the gold standard for treatment of benign prostatic hyperplasia (BPH). In general, while this procedure is safe, patients require a spinal, epidural, or general anesthesia and often several days of hospital stay; the potential morbidity and mortality limits the use of TURP in high-risk patients. Pharmacotherapy has been recommended as a first-line therapy for all patients with mild to moderate symptoms. Patients are often times enthusiastic if they are offered a one-time method to treat lower urinary tract symptoms secondary to BPH, provided that the method offers reduced risk and allows an efficacy equal to that of medical therapy. One such method is transurethral microwave thermotherapy (TUMT). TUMT involves the insertion of a specially designed urinary catheter with a microwave antenna, which heats the prostate and destroys hyperplastic prostate tissue. TUMT allows the avoidance of general or regional anesthesia, and results in minimal blood loss and fluid absorption. In this review, the authors discussed the current indications and outcome of TUMT, including the history of the procedure, the mechanism of action, the indications for TUMT, the pre-operative considerations, the patient selection, the results in terms of efficacy, by comparing TUMT vs. Sham, TUMT vs. Alpha-blocker and TUMT vs. TURP. Finally, the complications are presented, as well as other uses and future directions of the procedure. The authors concluded that TUMT is a safe and effective minimally invasive alternative to treatment of symptomatic BPH.     

经尿道反馈式微波治疗高危BPH

目的 评价经尿道反馈式微波治疗高危BPH患者的疗效及安全性.方法 高危BPH患者66例,其中年龄≥80岁者32例,合并高血压31例,糖尿病5例,心功能不全8例,慢性阻塞性肺病10例,脑梗死11例,骨折、截肢或关节僵硬不能截石位3例,凝血功能异常4例,胰腺炎2例,心律失常6例以及恶性肿瘤3例.尿道局部麻醉下采用个体化功率行经尿道反馈式微波治疗,使15%～30%前列腺组织凝固性坏死.对前列腺和周围组织温度实时监测并反馈,确保周围组织的安全.比较治疗前和治疗后3个月B超检查和最大尿流率检查以及国际前列腺症状评分(IPSS)和生活质量评分(QOL)结果.结果 66例患者均能耐受治疗,除轻微出血、感染及一过性尿失禁外,无明显外科并发症.前列腺体积由62.2 ml减少至44.5 ml,IPSS评分由治疗前(23.4±9.5)分降至(11.7±7.9)分,QOL由(4.5±1.2)分减少至(2.4±1.4)分,最大尿流率由(4.2±3.9)ml/s升高至(11.2±4.4)ml/s,治疗前后差异均有统计学意义(P<0.05). 结论 经尿道反馈式微波治疗高危BPH患者尤其是不能耐受麻醉的患者安全有效,并可用于门诊治疗.     

Transurethral microwave thermotherapy for benign prostatic hyperplasia

The clinical efficacy of transurethral microwave thermotherapy using the PROSTCARE apparatus was evaluated in 60 patients with bladder outlet obstruction associated with benign prostatic hyperplasia. All of the 60 patients received a single thermal session for 60 minutes with an average intraprostatic temperature of 45 degrees C. They were evaluated by analyzing the international prostate symptom score (IPSS), quality of life (QOL) index, maximum urinary flow rate and prostate volume at 2 months after the treatment to estimate criteria for efficacy of treatment in BPH. Both IPSS and QOL index improved significantly. The maximum urinary flow rate improved but there was no significant change. There was no significant change in prostate volume. The rates of improvement in IPSS, QOL index and maximum flow rate were 73%, 78% and 47% of the patients respectively. The rate of overall improvement was 78% of the patients. As a complication after the treatment, 2 patients complained of ejaculation disturbance.     

Transurethral microwave thermotherapy in benign prostatic hyperplasia

This article reviews the available literature and data on high-energy transurethral microwave therapy (TUMT) in the treatment of benign prostatic hyperplasia (BPH) causing lower urinary tract symptoms (LUTS). TUMT is a safe, durable, (1-hour) procedure, without the need for anesthesia. Emphasis is made on the effect and mechanism of TUMT, the different devices available including different energy protocols, and accompanying clinical results.     

Clinical results of microwave thermotherapy for benign prostatic hyperplasia

Transurethral microwave thermotherapy is a truly office procedure without the need for anesthesia for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia. Several devices have been developed. Continuous refinement of the procedure led to higher energy protocols and high-intensity dose protocols applying the heat-shock strategy. We report on the clinical results of these protocols. Symptom scores improve around 60%, whereas maximum urinary flow rate improve from an average 9 to 10 mL/sec at baseline to 14 to 15 mL/sec during follow-up. No significant differences have been shown between the outcomes with the different devices. Long-term data show satisfactory results after 4 years. Initial clinical results with the heat-shock strategy show results comparable to those of higher-energy protocols with decreased morbidity. Treatment morbidity of higher energy protocols is moderate and consists mainly of the need for catheterization and a higher percentage of retrograde ejaculation. To improve treatment efficacy, patient selection appears to be most important. Prostate size, bladder outlet obstruction, age, and prostate composition are of predictive value for treatment outcome. Further development of the treatment protocols and refinement of the urethral applicators might enhance outcome.     

Transurethral microwave thermotherapy for treatment of benign prostatic hyperplasia

Many urologists have a high regard for the usefulness of transurethral microwave therapy (TUMT) in treating patients with lower urinary tract symptoms caused by benign prostatic hyperplasia. This therapy has been examined clinically in many centers throughout the world. The rationale for its effect on symptoms is unlike many of the other so-called minimally invasive treatment modalities. The improvement in symptoms and voiding function is greater with transurethral microwave thermotherapy than with drug therapy, and the associated morbidity is low. It also offers greater versatility than drug therapy, allowing patients with severe baseline symptoms and small prostates to be treated successfully. In addition, there has been an evolution in the technology of TUMT from low-energy to high-energy application indicating that this technique has a future in the treatment of lower urinary tract symptoms.     

The use of intraurethral prostatic spiral in high risk patients for surgery with benign prostatic hyperplasia

Under local anaesthesia, 31 patients underwent insertion of an expandable stainless steel tubular spiral into the prostatic urethra under fluoroscopic control. All were considered to be at major risk from prostatic surgery. Most of them had long-term indwelling urethral catheters (14 patients). The spiral allowed unobstructed voiding and is a good alternative to an indwelling urethral catheter. We recommend insertion of a spiral in patients with urinary obstruction if they are unfit for surgery.     

Transurethral microwave thermotherapy vs transurethral resection for treating benign prostatic hyperplasia: a systematic review

OBJECTIVE: To conduct a systematic review of randomized controlled trials evaluating the efficacy and safety of transurethral microwave thermotherapy (TUMT) compared with transurethral resection of the prostate (TURP) in treating men with symptomatic benign prostatic hyperplasia (BPH). METHODS: We searched Medline, the Cochrane Library and reference lists of retrieved studies to identify randomized trials of >/= 6 months duration with >/= 10 patients in each treatment arm. Data were extracted on study design, patient and treatment characteristics, urinary symptoms, urinary flow, adverse events and repeat treatment for BPH. RESULTS: Six studies were evaluated, involving 540 patients. The mean age (67.8 years), baseline symptom score (19.5), and peak urinary flow (PUF, 8.6 mL/s) did not differ by treatment group. The pooled mean urinary symptom score decreased by 65% with TUMT and 77% with TURP. The weighted mean (95% confidence interval) difference for the symptom score at the follow-up was -1.83 (-3.09 to -0.58) points, favouring TURP. The pooled mean PUF increased by 70% with TUMT and 119% with TURP. The weighted mean difference for the PUF at the follow-up was 5.37 (4.22-6.51) mL/s, favouring TURP. Retrograde ejaculation (57.6% vs 22.2%), transfusions (5.7% vs 0%) and re-treatment for strictures (relative hazard 9.76) were all significantly more common after TURP, but re-treatment for BPH was significantly more common after TUMT (relative hazard 10.0). CONCLUSIONS: TUMT techniques are effective and safe short-term alternatives to TURP for treating BPH. However, TURP provided greater symptom and urinary flow improvements and fewer subsequent BPH treatments than TUMT.     

经尿道反馈式微波治疗高危前列腺增生随访2年结果分析

目的 评价高危BPH采用经尿道反馈式微波治疗随访2年的疗效.方法 高危BPH患者62例(含门诊患者2例),均为年龄≥80岁或并发重要器官及系统严重病变或功能损害.治疗前前列腺体积、IPSS、QOL、Qmax分别为(62.03±50.69)ml、23.19±9.33、4.58±1.09、(4.33±3.75) ml/s.62例均在尿道表面麻醉下采用经尿道反馈式微波治疗,分别在治疗后3、12、24个月复查B超测量前列腺体积,复测IPSS、QOL及Qmax. 结果 62例均能耐受治疗,除轻微出血、感染及一过性尿失禁外,无明显外科并发症.治疗后3个月前列腺体积、IPSS评分、QOL评分、Qmax分别为(43.85±33.48)ml、11.63±7.14、2.44±1.36、(11.44±4.20) ml/s,治疗后12个月为(45.10±33.38) ml、12.23±7.33、2.61±1.33、(10.91±4.05) ml/s,治疗后24个月为(45.80±33.46) ml、12.37±7.48、2.66±1.40、(10.82±4.03) ml/s.治疗后各个时间点的各项指标均较治疗前显著改善(P＜0.01). 结论 经尿道反馈式微波治疗高危BPH患者长期安全有效,可用于门诊治疗,治疗后3个月达到最佳疗效.     

Long-term results of microwave thermotherapy for symptomatic benign prostatic hyperplasia

PURPOSE: To study the long-term outcomes of men with moderately severe symptomatic benign prostatic hyperplasia (BPH) who were treated with transurethral microwave thermotherapy (TUMT) with the Dornier Urowave machine. PATIENTS AND METHODS: A total of 220 patients (mean age 66.2 years) with clinical BPH, an American Urological Association (AUA) Symptom Score of >or=13, and a peak urinary flow rate (Qmax) of 相似文献   

Preliminary results of transurethral microwave thermotherapy in the treatment of benign prostatic hyperplasia in Turkey.

This prospective study was conducted in order to evaluate the efficacy of transurethral microwave thermotherapy (TUMT) in the treatment of benign prostatic hyperplasia (BPH). A single TUMT session of 55 min was delivered as an ambulatory procedure without anesthesia to 180 patients. 20 (69%) of the 29 patients who were catheterized due to urinary retention prior to the treatment were able to urinate freely after the treatment. In 91 patients with a follow-up of 3 months, the mean maximum flow rate (MFR) was 7.9 ml/s prior to the treatment and 12.1 ml/s after the treatment (p less than 0.02). The mean residual urine after voiding (PVR) of these patients was 104 and 54 ml before and after TUMT, respectively (p = 0.0001). The mean Madsen symptom score (SS) was 14 before and 7.5 after the treatment (p = 0.0001). The patients with pretreatment MFR higher than 7.0 ml/s, PVR less than 150 ml and SS lower than 15 benefited better from TUMT. As the findings indicated, TUMT is an alternative treatment modality in BPH in selected cases, although the number and the follow-up of our series are insufficient to draw a precise conclusion yet.     

The cost of feedback microwave thermotherapy compared with transurethral resection of the prostate for treating benign prostatic hyperplasia

OBJECTIVE: To compare the efficacy of a new microwave thermotherapy for treating benign prostatic hyperplasia (BPH), the ProstaLund Feedback Treatment (PLFT, ProstaLund Operations AB, Lund, Sweden) and transurethral resection of the prostate (TURP) in a clinical trial to their effectiveness in clinical practice over 1 year, to estimate their cost over 1 year, and to evaluate the cost of re-interventions over a longer period (2-3 years). PATIENTS AND METHODS: In a large randomized international 1-year clinical trial PLFT was as effective as TURP in improving symptoms of BPH and urinary flow. Because PLFT is an outpatient procedure it was less costly than TURP. However, the cost-effectiveness of the new procedure depends on its long-term effectiveness in clinical practice. All 146 patients in the randomized clinical trial were included in the present analysis. The outcome was based on the International Prostate Symptom Score (IPSS) and the bother score, and costs were estimated from treatment-related adverse events and hospitalization. To validate the estimates based on the clinical trial 1-year data on effectiveness and complete resource use in clinical practice were collected in a retrospective observational study from hospital charts and patient questionnaires of 88 patients who had undergone either TURP or PLFT. To assess the number of re-interventions after TURP after the first year information was obtained from hospital and surgical procedure data in the Swedish inpatient registry. The 3-year data for a total of 52,010 patients who had an index hospitalization for TURP between 1990 and 1995 were available for the analysis. The estimate of long-term consequences of PLFT was based on complication and re-intervention data for 87 patients who had undergone PLFT between 1997 and 1999. RESULTS: The mean 1-year costs in the clinical trial were estimated at [symbol: see text] 1763 for PLFT and [symbol: see text] 3209 for TURP. When all treatment-related resource use in clinical practice for 88 patients was included the costs were estimated at [symbol: see text] 1924 and [symbol: see text] 3264 for PLFT and TURP, respectively. The IPSS and bother scores were not significantly different between the groups in both datasets. Using the registry data the cost of TURP including re-interventions (TURP and bladder neck incisions) was estimated at [symbol: see text] 3159 over 2 years and [symbol: see text] 3185 over 3 years; the respective costs for PLFT were [symbol: see text] 2121 and at [symbol: see text] 2151. CONCLUSIONS: In the 1-year clinical trial PLFT was as effective but less costly than TURP, but long-term data are still lacking. However, the preliminary analysis over 3 years indicates that the average cost of the procedure remains lower than the total cost of TURP for the same period.     

Durability of results obtained with transurethral microwave thermotherapy in the treatment of men with symptomatic benign prostatic hyperplasia

To assess the durability of the results of transurethral microwave thermotherapy (TUMT) for symptomatic benign prostatic hyperplasia (BPH), we have reviewed publications describing trials with at least 3 years of follow-up. For men treated only by TUMT, improvement in symptoms and quality of life appears to be maintained for at least 4 to 5 years. Improvement in peak flow rates is modest but is generally maintained, particularly after higher-energy therapies. These results represent responders, and a crucial question is the need for additional treatments. With lower-energy treatment, this is common: between 50% and 60% within 3 to 5 years. With higher-energy TUMT, the retreatment rate appears to be less, approximating 20% within 3 to 4 years. When comparing these results with those of transurethral resection, it should be noted that there is a significant failure rate with surgery, and even if failure is more common with TUMT, men may be prepared to accept this risk rather than the greater morbidity of prostatectomy.