Premium
Transrectal Hyperthermia in the Management of Men with Prostatism: An Algorithm for Therapy
Author(s) -
KAPLAN S. A.,
SHABSIGH R.,
SOLDO KATHERINE A.,
BLAIVAS J. G.,
OLSSON C. A.
Publication year - 1993
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1993.tb00687.x
Subject(s) - prostatism , medicine , prostatic urethra , urology , hyperthermia , hyperplasia , prostate , international prostate symptom score , lower urinary tract symptoms , urethra , prostate disease , cancer
Summary— Transrectal hyperthermia has been proposed as a potential treatment for benign prostatic hyperplasia (BPH). This report presents our initial experience in an ongoing clinical trial to evaluate the safety and efficacy of transrectal thermal therapy (TRTT) for symptomatic BPH. To date, 24 patients (mean age 60.6 years) have undergone TRTT. In all cases the initial investigations included pre‐operative symptom score analysis, synchronous video/pressure/flow urodynamic studies and transrectal measurement of both the size of the prostate and the distance between the applicator and the prostatic urethra (AU). Twenty‐one patients completed the study (mean followup 6.7 months). There was a significant reduction in symptom score (>50%) in 14 patients and the peak urinary flow rate (Q max ) increased from 5.9 to 12.4 ml/s at 1 month, 12.7 ml/s at 3 months and 13.2 ml/s at 6 months. In 12 patients the decrease in symptom score and the increase in flow rate exceeded 50%. Five of the 6 patients who failed to respond to treatment had prostate volumes > 85 g; 4 had voiding detrusor pressures < 40 cm H 2 O and 5 had an AU distance >2.5 cm. These preliminary results suggest that TRTT may be a potential therapeutic alternative in patients with mild to moderate symptoms of prostatism. However, patients with either lower detrusor pressures (< 40 cm H 2 O) or very large prostates are unlikely to show a beneficial response. We suggest that large prostates may preclude effective temperature distribution and therefore mitigate the potential therapeutic benefit.