Effectiveness and Predictive Value of Responsiveness of the Transurethral Microwave Thermotherapy in the Treatment of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: To evaluate the clinical efficacy and durability of transurethral microwave thermotherapy (TUMT) in the treatment of benign prostatic hyperplasia, the useful clinical factors were retrospectively investigated. MATERIALS AND METHODS: Between September 1997 and July 2003, 113 patients with symptomatic benign prostatic hyperplasia were treated with TUMT (Prostatron with Prostasoft 2.5). 64 patients were followed up at 3, 6 and 12 months after treatment. Treatment outcomes were evaluated by the International Prostate Symptom Score (IPSS), quality of life (QoL) score and by urodynamic investigation. The patients were divided into responders and non-responders on the basis of their response evaluation criteria. RESULTS: The mean IPSS, QoL score, peak flow rate, mean flow rate and post-voiding residual volume were significantly improved after TUMT (p<0.05). The pretreatment QoL score of the responders was significantly lower than that of the non-responders (p<0.05), and peak and average flow rates of the responders were significantly higher than those of the non-responders (p<0.05). Lower prostate-specific antigen (PSA), lower residual volume and higher energy had trends toward a good prognosis (0.05

Could Serum Level of Prostate-specific Antigen after High Energy Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia Predict and Represent Efficacy of the Treatment? / 대한비뇨기과학회지

PURPOSE: To investigate serum level of prostate-specific antigen(PSA) after high energy transurethral microwave thermotherapy(HE-TUMT) for benign prostatic hyperplasia(BPH) could predict and represent efficacy of the treatment. MATERIALS AND METHODS: In patients with BPH who underwent HE-TUMT using Prostatron with Prostasoft 2.5(EDAP-Technomed, France), serum levels of PSA at 7 days(n=37), 3 months(n=40), and 6 months(n=26) after the treatment were compared with Madsen and international prostate symptom score(MSS and IPSS), maximal and average uroflow rate(MFR and AFR), and postvoiding residual urine(PVR) of 6 months after the treatment. RESULTS: The subjective(MSS and IPSS) and objective(PFR, AFR, and PVR) parameters were significantly(p<0.05) improved at 6 months after the treatment. The postoperative serum level of PSA showed a 643.2% increase(0.5-2870%) at 7 days(more than 500% increase in 18 men and less than 500% in 19), a 34.9% increase(79% decrease?303% increase) at 3 months, and a 8.5% decrease(74.7% decrease?53.7% increase). There was no significant difference in the both subjective and objective parameters at 6 months between the two groups; more and less than 500% increase on the 7th day, and among the three groups; more than 20% decrease(n=14), less than 20% decrease or increase(n=13), and more than 20% increase(n=13). However, improvement of MFR and AFR was significantly(p<0.05) higher at 6 months in 20% decrease group(n=9) compared with that of the remainder(n=17) although symptom scores and PVR not significantly different. CONCLUSIONS: Serum level of PSA at 7 days and 3 months after HE-TUMT could not predict efficacy of the treatment at 6 months. However, the extent of decrease in PSA level may represent relieved bladder outlet obstruction resulting from reduction of prostate volume.

Role of Transurethral Microwave Thermotherapy for Urinary Retention due to Benign Prostatic Hyperplasia in High-Risk Surgical Patients / 대한비뇨기과학회지

PURPOSE: To evaluate the outcome of transurethral microwave thermotherapy(TUMT) for the treatment of urinary retention due to benign prostatic hyperplasia(BPH) in the high-risk surgical patients. MATERIALS AND METHODS: From November, 1992 to March, 1997, a total of 26 patients with urinary retention due to BPH underwent TUMT with PRIMUS U+R because of poor physical and medical status at the department of urology, Red Cross hospital in Seoul. Mean patient age was 73years(range 58 to 97years), mean prostatic weight was 35gm(range 14gm to 68gm) and mean duration of retention was 1.7 months(range 1 day to 36months). The once or twice 1-hour TUMT session was well tolerated and without significant adverse effect. Patients were divided into responder and non-responder. In responder group who were catheter free after TUMT, peak flow rate and post-void residual urine(PVR) were assessed at 3, or 6, or 12months of follow-up. RESULTS: Of 26 patients, 16 patients were responders(61.5%) after TUMT for the duration of follow-up. The mean peak flow rate and post-voiding residual urine during 12months of follow-up period were 10.4m1/sec(range 3 to 22m1/sec) and 62.8ml(range 0 to 269m1), respectively. There was no major complication. CONCLUSIONS: From these results TUMT appears to be safe and erective treatment modality in the high-risk surgical patients.

Changes in Symptom Score and Uroflowmetry in 3 and 6 Months after Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia / 대한남성과학회지

PURPOSE: To evaluate the effectiveness of transurethral microwave thermotherapy (TUMT) using the Prostatron with Prostasoft 2.5 software in the patients with benign prostatic hyperplasia(BPH). PATIENTS AND METHODS: Patients with a Madsen symptom score (MSS) and International Prostate Symptom Score (IPSS) of 8 or more and a maximal uroflow rate of 15mL/sec or less were treated. Fifty-five patients (mean age 64.5 years, range 54~75 years) were followed up for 3 months and 23 patients (mean age 63.9 years, range 52~72 years) for 6 months. The MSS, IPSS, and uroflowmetry values (maximal flow rate, average flow rate, delay time, flow time, voiding time, time to maximal flow, and postvoiding residual volume), and quality of life were measured at baseline and 3 and 6 months after TUMT. RESULTS: The MSS (14.7 vs. 5.42, 14.2 vs. 3.90), IPSS (21.6 vs. 9.57, 20.0 vs. 6.73), and quality of life (4.37 vs. 2.53, 4.24 vs. 1.86) were significantly improved at 3 and 6 months after treatment (p<0.01). All uroflowmetry values except delay time were significantly improved at 3 months (p<0.01); at 6 months, the maximal flow rate (11.0 vs. 14.3 mL/sec), residual urine (70.3 vs. 22.6 mL) (p<0.01), and average flow rate (5.26 vs. 7.19 mL/sec) (p<0.05) were improved. CONCLUSIONS: High-energy TUMT could be an effective and safe method for the treatment of symptomatic BPH. Further studies on the long-term outcome of this procedure are necessary.

The Clinical Effects of Transurethral Microwave Thermotherapy in Case of Benign Prostatic Hyperplasia with Urinary Retention / 대한비뇨기과학회지

From February, 1993 to April, 1994, 32 benign prostatic hyperplasia( BPH) patients with urinary retention were treated with transurethral microwave thermotherapy(TUMT). The mean patient age was 74 years(range 59 to 86 years) and the mean duration of retention was 3.7 months(range 1 day to 36 months). The mean follow-up period was 13 months (range 4 to 18 months). In cystoscopic findings, trilobar hyperplasia was diagnosed in 12 patients(37% ), while bilobar and median bar or median lobe enlargement were diagnosed in 11 patients(35% ) and 9 patients( 28% ). Mean prostatic weight was 29gm(range 11.3 to 89.5gm) Of the patients 14(44% ) patients were in the catheter-free state( = Responder) after TUMT and 18(56%) patients had to be in the catheter-indwelling state( = Nonresponder). The 14 responders showed several important parameters: mean peak flow rate was 8.9ml per second ( range 4.5 to 17.5ml per second), mean post-voiding residual urine was 137.5ml( range 80 to 220ml) and a mean symptom score was 10.7 on the modified Boyarski symptom score scale. Also, there was no significant difference in the incidence of catheter-free state in patients with bilobar and trilobar hyperplasia compared to those with median bar or median lobe hyperplasia. Conclusively, one session of TUMT at 50 degrees C for 90 minutes seemed to have minor therapeutic effect on BPH patients with urinary retention. Therefore, the clinical results in treating the BPH patients with urinary retention suggest that the more clinical experiences will be needed about the proper patient selection, the safety introduction of higher temperature, the prolonged treatment time and the numbers of treatment session.

Preliminary Experience of Transurethral Microwave Thermotherapy / 대한비뇨기과학회지

Between November 1992 and August 1993, 46 patients with symptomatic benign prostatic hyperplasia were treated with transurethral microwave thermotherapy with PRIMUS U+R. We excluded the patients with absolute indications for transurethral resection of the prostate and median lobe enlargement. Of the inpatients who had acute retention, 13 patients were entered into this study, because they were at greater risk from cardiac disease and they rejected surgery. Of the 33 patients who were able to void at presentation, 11 patients were treated with two sessions because of unsatisfactory improvement of symptom scores or peak flow rate. For analysis we divided the patients into 3 groups based on treatment session and retention, such as group 1 (single session, n=22), group 2 (two sessions, n=11) and group 3 (acute retention, single session, n= 13). Uroflow rates, FDA symptom score and post-void residual volume were measured at 4 weeks, 3 and 6 months. Of 33 patients who had no retention at presentation. 22 patients(67%) had a satisfactory results after one treatment session. The obstructive score, irritative score and peak flow rates improved 60%, 43% and 57%. respectively (all p <0.0001). Of 33 men 11(33%) reported improvement after 2 sessions in symptom scores and post-void residual volume, but there was no statistically significant improvement in peak flow rate. In group 3, 7 patients (54% ) were able to void after treatment. This study demonstrated safety and effectiveness of transurethral microwave thermotherapy.