Durability of 30-Minute High-Energy Transurethral Microwave Therapy for Treatment of Benign Prostatic Hyperplasia: A Study of 213 Patients With and Without Urinary Retention (original) (raw)
Related papers
Urology, 1999
Objectives. Improved long-term results with respect to symptoms, voiding function, and quality of life (QOL) in patients with lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH) are achieved with targeted high-energy transurethral microwave thermotherapy (TUMT) compared with alpha-blocker treatment alone. However, maximal improvement after TUMT is not attained until 3 to 6 months after treatment. Measures to provide earlier symptom relief and improved voiding function and QOL would add to the clinical utility of TUMT. The objective of the present study was to determine whether neoadjuvant and adjuvant alpha-blockade is capable of accelerating a post-TUMT decrease in LUTS of patients with BPH. Methods. In this randomized, prospective study of 81 patients with LUTS of BPH, 41 underwent TUMT with neoadjuvant and adjuvant tamsulosin (0.4 mg daily) treatment, and 40 had TUMT alone. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and QOL score were determined before treatment and at periodic intervals thereafter up to 12 weeks after TUMT.
Urology, 1998
Objectives. This is the first and largest single institution retrospective study in the United States to examine the effects of transurethral microwave thermotherapy (TUMT) for the treatment of benign prostatic hyperplasia (BPH). Methods. From September 1996 to June 1997, 78 men with moderate to severe symptomatic BPH were treated with the Prostatron at our institution. Patient age ranged from 52 to 85 years. Prostate volume ranged from 23 to 110 cc, and mean total energy applied during the treatment was 156.17 kJ. Patients were re-evaluated at 3 months and were asked to answer a questionnaire regarding their opinion about the treatment. Results. At 3 months there was a significant decrease in mean symptom score from 19.6 to 11.2 (P Ͻ0.0001). Mean peak flow rate increased from 8.5 to 12.8 mL/s (P Ͻ0.0001). Mean postvoid residual urine decreased from 56.8 to 22.0 mL (P Ͻ0.0001). We did not observe any severe complications. Unlike prior studies, we removed the Foley catheter, and patients performed clean intermittent catheterization (CIC) when necessary. There was no significant differences in subjective and objective parameters between these patients and those who did not need CIC. Patient opinion about the treatment was not affected by CIC. About two thirds (67.2%) of the patients in the study group were satisfied with the results of treatment, and 60.3% would undergo the same procedure again. Conclusions. TUMT of the prostate is an effective, safe, and acceptable form of treatment for patients with BPH. Longer follow-up is needed to examine the durability of TUMT treatment.
Urology, 2007
OBJECTIVES To compare the efficacy and safety of transurethral microwave thermotherapy (TUMT) with ProstaLund Feedback Treatment, using the CoreTherm device, with transurethral resection of the prostate (TURP) 5 years after treatment. METHODS This prospective, randomized, multicenter study was conducted at 10 centers in the United States and Scandinavia. A total of 154 patients with benign prostatic hyperplasia were randomized to TUMT or TURP in a 2:1 ratio. Patients were followed up at 3, 6, 12, 24, 36, 48, and 60 months after treatment. The intermediate results at 12 and 36 months have been previously reported. The treatment outcome at 5 years was evaluated with the International Prostate Symptom Score (IPSS), quality of life question (QOL), peak urinary flow rate (Qmax), postvoid residual urine volume, and prostate volume. The CoreTherm device differs from other microwave devices in that the intraprostatic temperature is constantly measured during the procedure to guide the treatment. RESULTS Of the 154 patients, 66% completed the 60 months of follow-up. Statistically significant improvements in the TUMT and TURP groups were observed for IPSS, QOL, and Qmax at 60 months. The average values for the TUMT group were an IPSS of 7.4, QOL score of 1.1, and Qmax of 11.4 mL/s. The values for the TURP group were IPSS of 6.0, QOL score of 1.1, and Qmax of 13.6 mL/s. No statistically significant differences were found in any of these variables between the two treatment groups. In the TUMT group, 10% needed additional treatment versus 4.3% in the TURP group. CONCLUSIONS The clinical outcome 5 years after TUMT using the CoreTherm device was comparable to the results seen after TURP. The safety of TUMT using the CoreTherm device compared favorably with that of TURP. UROLOGY 69: 91-97, 2007.
High-energy transurethral microwave thermotherapy: symptomatic vs urodynamic success
BJU International, 2003
All patients completed at least 1 year of follow-up after TUMT as monotherapy. The symptom score improved from a median (range) of 20.5 (11-28) initially to 9 (0-28) ( P < 0.001). Twenty-two patients (55%) had a marked and 11 (28%) a moderate response, giving an overall subjective success rate of 83%. Similarly, there was a significant improvement in peak flow rate, from 9.2 (4.4-13.4) to 15 (3.3-22.9) mL/s ( P < 0.001). Twenty-one patients (53%) had a maximum flow rate of > 15 mL/s while in eight (20%) it was 10-15 mL/s. Only 20 patients changed from unobstructed on the pressure-flow nomogram, i.e. an overall objective success rate of 50%. Gadolinium-enhanced T1weighted MRI 1 week after treatment showed a median (range) perfusion defect of 20.7 (5.5-76.6)% of the total gland volume. Despite this persisting in all patients, a welldefined cavity was apparent in only in seven (18%) at the final evaluation. Cystoscopy
Urology, 2012
OBJECTIVE To compare the 12-month postoperative clinical data in patients with comorbidities undergoing plasmakinetic enucleation of the prostate (PK-TURP) and monopolar transurethral resection of the prostate (M-TURP) for symptomatic benign prostatic hyperplasia (BPH). METHODS The data of 165 patients undergoing either PK-TURP or M-TURP from September 2006 to December 2010 were retrospectively evaluated in terms of erectile function. Decrease in Hb level at 24-hour follow-up, variations in serum Na ϩ at 2-hour follow-up, and 12 month postoperative International Prostate Symptom Score (IPSS), Q max. , postoperative International Index of Erectile Function (IIEF) scores and urethral stricture rates were evaluated. RESULTS A total of 85 patients underwent M-TURP and 80 patients PK-TURP. In all, 62 patients in M-TURP group and 71 patients in PK-TURP group had one or more comorbidities (P ϭ .01). The operative times were 59.8 Ϯ 17.8 versus 60.3 Ϯ 23.8 (P ϭ 0.539). The postoperative 12-month IIEF scores of PK-TURP patients were significantly higher than those of M-TURP patients (M-TURP; 14.5 Ϯ 6.9, PK-TURP; 17.4 Ϯ 8.9, P ϭ .04). IPSS and Q max. were similar in both the M-TURP and PK-TURP treatment arms (10.9 Ϯ 8.1 versus 9 Ϯ 7.9, P ϭ .187 and 18.9 Ϯ 4.8 versus 18.8 Ϯ 6.4, P ϭ .905). Urethral stricture rate was 3/62 in M-TURP versus 8/71 in PK-TURP treatment arm, P ϭ .171). CONCLUSION Both modalities yielded similar results with respect to IPSS and Q max.. The postoperative IIEF in BPH patients with comorbidities appeared to be significantly higher in the PK-TURP group. Although urethral stricture rates seemed higher in the PK-TURP arm, the difference was not statistically significant. UROLOGY 80: 402-407, 2012.
Int Braz J Urol, 2021
Objective: To generate high-quality data comparing the clinical efficacy and safety profile between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). Materials and Methods: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). Inclusion criteria: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. Exclusion criteria: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment efficacy evaluated at 1, 3, 6 and 12 months. Efficacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. Results: Out of the 100 hundred patients, 84 qualified for the analysis (45 M-TURP/39 PK-TURP). No significant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is "rigorous" (Jadad-scale) and has a low risk of bias (Cochrane-Handbook). Conclusions: Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.