PTU - Polskie Towarzystwo Urologiczne
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Long-term history of patients who underwent high-energy transurethral microwave thermotherapy of the prostate
Article published in Urologia Polska 2006/59/3.

authors

Tomasz Jakubczyk, Andrzej Stokłosa, Piotr Kryst, Andrzej Borkowski
Katedra i Klinika Urologii Akademii Medycznej w Warszawie

keywords

prostate, benign prostatic hyperplasia, thermotherapy

summary

Introduction. High-Energy Transurethral Microwave Thermotherapy (HE-TUMT) is an accepted method of treatment of benign prostatic hyperplasia (BPH), however long-term results are lacking.
Objectives. The aim of the study was the assessment of long-term results of HE-TUMT.
Materials and methods. Men with BPH, who preferred such treatment or were unfit for Transurethral Resection of Prostate (TURP) or open prostatectomy underwent HE-TUMT. LUTS, quality of life (QoL), peak (PFR) and average (AVR) flow rates as well as post-void residual volume (PVR) were analyzed. Study was conducted in a prospective fashion during 12 months after HE-TUMT, long-term results were assessed retrospectively in 2005.
Results. Results of HE-TUMT were assessed in 44 patients. Within study period 16 required additional treatment (8 - pharmacotherapy, 3 - urethrotomy, 4 - TURP, 1 - open prostatectomy). Five patients died, not requiring additional therapy, 9 were lost to follow-up. In the remaining group mean follow-up was 65,7 (42-78, SD 9,6) months. LUTS decreased by 45, 43 and 43% after 6, 12 and an average of 65,7 months, QoL by 35, 35 i 43%, while PVR by 37, 47 i 36%, respectively. PFR increased respectively by 35, 17 i 29%, while AVR by 29, 15 i 37%. No clinically significant complications were found.
Conclusions. HE-TUMT is a safe and in many cases effective method of BPH treatment, also concerning long-term results. For patients with increased peri-operative risk HE-TUMT with or without pharmacotherapy remained the only possible method of BPH treatment.

references

  1. de la Rosette JJ, Alivizatos G, Madersbacher S: EAU Guidelines on benign prostatic hyperplasia (BPH). Eur Urol 2001, 40 (3), 256-263.
  2. Larson TR, Bostwick DG, Corica A: Temperature-correlated histopathologic changes following microwave thermoablation of obstructive tissue in patients with benign prostatic hyperplasia. Urology 1996, 47 (4), 463-469.
  3. Brehmer M: Morphological changes in prostatic adenomas after transurethral microwave thermotherapy. Br J Urol 1997, 80 (1), 123-127.
  4. Mauroy B, Chive M, Stefaniak X, Demetriou D et al: Study of the effects of thermotherapy in benign prostatic hypertrophy. Eur Urol 1997, 32 (2), 198-208.
  5. Brehmer M, Svensson I: Heat-induced apoptosis in human prostatic stromal cells. BJU Int 2000, 85 (4), 535-541.
  6. Bdesha AS, Schachter M, Sever P, Witherow RO: Radioligand-binding analysis of human prostatic alpha-1 adrenoreceptor density following transurethral microwave therapy. Br J Urol 1996, 78 (6), 886-892.
  7. Brehmer M, Baba S: Transurethral microwave thermotherapy, how does it work? J Endourol 2000, 14 (8), 611-615.
  8. Perlmutter AP, Perachino M: Mechanism of microwave thermotherapy. World J Urol 1998, 16 (2), 82-88.
  9. Blute ML: Transurethral microwave thermotherapy, minimally invasive therapy for benign prostatic hyperplasia. Urology 1997, 50 (2), 163-166.
  10. Pomer S, Dobrowolski ZF: The therapy of benign prostatic hyperplasia using less-invasive procedures, the current situation. BJU Int 2002, 89 (7), 773-775.
  11. Eliasson T, Damber JE: Temperature controlled high energy transurethral microwave thermotherapy for benign prostatic hyperplasia using a heat shock strategy. J Urol 1998, 160 (3 Pt 1), 777-781.
  12. de la Rosette JJ, Francisca EA, Kortmann BB et al: Clinical efficacy of a new 30-min algorithm for transurethral microwave thermotherapy, initial results. BJU Int 2000, 86 (1), 47-51.
  13. Pace G, Selvaggio O, Palumbo F, Selvaggi FP: Initial experience with a new transurethral microwave thermotherapy treatment protocol \'30-minute TUMT\'. Eur Urol 2001, 39 (4), 405-411.
  14. de la Rosette JJ, de Wildt MJ, Hofner K et al: High energy thermotherapy in the treatment of benign prostatic hyperplasia, results of the European Benign Prostatic Hyperplasia Study Group. J Urol 1996, 156 (1), 97-101.
  15. D\'Ancona FC, Albers YH, Kiemeney LA et al: Can histopathology predict treatment outcome following high-energy transurethral microwave thermotherapy of the prostate? Results of a biopsy study. Prostate 1999, 40 (1), 28-36.
  16. de la Rosette JJ, de Wildt MJ, Hofner K et al: Pressure-flow study analyses in patients treated with high energy thermotherapy. J Urol 1996, 156 (4), 1428-1433.
  17. de Wildt MJ, Debruyne FM, de la Rosette JJ: High-energy transurethral microwave thermotherapy: a thermoablative treatment for benign prostatic obstruction. Urology 1996, 48 (3), 416-423.
  18. de Wildt MJ, Hubregtse M, Ogden C et al: A 12-month study of the placebo effect in transurethral microwave thermotherapy. Br J Urol 1996, 77 (2), 221-227.
  19. Javle P, Blair M, Palmer M et al: The role of an advanced thermotherapy device in prostatic voiding dysfunction. BJU Int 1996, 78, 391-397.
  20. Osman Y, Wadie B, El Diasty T, Larson T: High-energy transurethral microwave thermotherapy: symptomatic vs urodynamic success. BJU Int 2003, 91 (4), 365-370.
  21. D\'Ancona FC, Francisca EA, Debruyne FM, de la Rosette JJ: High-energy transurethral microwave thermotherapy in men with lower urinary tract symptoms. J Endourol 1997, 11 (4), 285-289.
  22. Thalmann GN, Mattei A, Treuthardt C et al: Transurethral microwave therapy in 200 patients with a minimum followup of 2 years: urodynamic and clinical results. J Urol 2002, 167 (6), 2496-2501.
  23. Gravas S, Laguna MP, de la Rosette JJ: Efficacy and safety of intraprostatic temperature-controlled microwave thermotherapy in patients with benign prostatic hyperplasia: results of a prospective, open-label, single-center study with 1-year follow-up. J Endourol 2003, 17 (6), 425-430
  24. Thalmann GN, Graber SF, Bitton A et al: Transurethral thermotherapy for benign prostatic hyperplasia significantly decreases infravesical obstruction: results in 134 patients after 1 year. J Urol 1999, 162 (2), 387-393.
  25. Jakubczyk T: Przezcewkowa wysokoenergetyczna termoterapia mikrofalowa w leczeniu chorych z łagodnym rozrostem stercza. Rozprawa na tytuł doktora nauk medycznych. Akademia Medyczna w Warszawie, 2005 r.
  26. Krogh J, Hansen F, Nordling J: Transurethral microwave thermotherapy for treatment of benign prostatic hyperplasia: results obtained with the Prostalund device. World J Urol 1998, 16 (2), 115-119.
  27. Miller PD, Kastner C, Ramsey EW, Parsons K: Cooled thermotherapy for the treatment of benign prostatic hyperplasia: durability of results obtained with the Targis System. Urology 2003, 61 (6), 1160-1164.
  28. Ramsey EW, Miller PD, Parsons K: Transurethral microwave thermotherapy in the treatment of benign prostatic hyperplasia: results obtained with the Urologix T3 device. World J Urol 1998, 16 (2), 96-101.
  29. Trock BJ, Brotzmann M, Utz WJ et al: Long-term pooled analysis of multicenter studies of cooled thermotherapy for benign prostatic hyperplasia: results at three months through four years. Urology 2004, 63, 716-721.
  30. Floratos DL, Kiemeney LA, Rossi C et al: Long-term followup of randomized transurethral microwave thermotherapy versus transurethral prostatic resection study. J Urol 2001, 165 (5), 1533-1538.
  31. Wagrell L, Schelin S, Nordling J et al: Three-year follow-up of feedback microwave thermotherapy versus TURP for clinical BPH: a prospective randomized multicenter stury. Urology 2004, 64, 698-702.

correspondence

Tomasz Jakubczyk
Klinika Urologii AM
ul. Lindleya 4
02-005 Warszawa
tel. (022) 502 1723
tojak@amwaw.edu.pl