Efficacy of high-energy transurethral microwave thermotherapy in alleviating medically refractory urinary retention due to benign prostatic hyperplasia

Kellner, Daniel; Armenakas, Noel A.; Brodherson, Michael; Heyman, Jacob; Fracchia, John A.

doi:10.1016/j.urology.2004.04.074

Cited by 14 publications

(9 citation statements)

References 12 publications

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“…In the studies by Schelin [6] and Schelin et al [11] all of the patients were suitable for surgery. In the studies by Naqvi et al [5], Kellner et al [9] and Djavan et al [4] the percentage of patients unsuitable for surgery owing to comorbidities was 15%, 51% and 87%, respectively. In this study both the mean age (79 years) and the percentage of patients unsuitable for surgery (62%) were higher than in the majority of previous similar studies.…”

Section: Discussionmentioning

confidence: 95%

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Transurethral microwave thermotherapy treatment of chronic urinary retention in patients unsuitable for surgery

Aagaard

Niebuhr

Jacobsen

et al. 2013

Scandinavian Journal of Urology

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Section: Discussionmentioning

confidence: 95%

“…In the studies by Djavan et al [4] and Naqvi et al [5] the mean age was 66 and 67 years, respectively. In the remaining studies mentioned above the mean age was either 73 or 74 years [6,[9][10][11][12]. The percentage of patients seen as high risk and unsuitable for surgery varied in these studies.…”

Section: Discussionmentioning

confidence: 99%

Transurethral microwave thermotherapy treatment of chronic urinary retention in patients unsuitable for surgery

Aagaard

Niebuhr

Jacobsen

et al. 2013

Scandinavian Journal of Urology

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“…The multisectored tubular ultrasound device configuration could be useful for thermal ablative treatment of BPH, which typically targets the anterior/lateral lobes of the human prostate to reduce obstructive hyperplasic tissue. 8,9,45 Compared to TUMT devices, these multisectored transurethral ultrasound applicators offer increased spatial heating control both in positioning toward the bladder neck and in directing the energy into the anterior/lateral portion of the gland. This improved control, coupled with faster treatment times and greater heating penetration, may improve overall clinical efficacy and durability.…”

Section: Discussionmentioning

confidence: 99%

“…2,7 In addition, studies have been conducted that indicate higher temperatures produced from high-energy TUMT devices may improve postprocedure symptom scores. 8,9 Transurethral thermal therapy appears to be an effective option for treating BPH, but the evidence suggests that increased spatial control of the temperatures and more accurate targeting of the anterior/lateral lobes of the prostate may further improve treatment. 10,11 For treating prostate cancer, thermal therapy is typically used as an alternative to radical prostatectomy in high risk patients who are not surgical candidates and for treatment of local recurrence after external beam radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Transurethral ultrasound applicators with dynamic multi‐sector control for prostate thermal therapy: In vivo evaluation under MR guidance

et al. 2008

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The purpose of this study was to explore the feasibility and performance of a multi-sectored tubular array transurethral ultrasound applicator for prostate thermal therapy, with potential to provide dynamic angular and length control of heating under MR guidance without mechanical movement of the applicator. Test configurations were fabricated, incorporating a linear array of two multisectored tubular transducers ͑7.8-8.4 MHz, 3 mm OD, 6 mm length͒, with three 120°independent active sectors per tube. A flexible delivery catheter facilitated water cooling ͑100 ml min −1 ͒ within an expandable urethral balloon ͑35 mm longϫ 10 mm diameter͒. An integrated positioning hub allows for rotating and translating the transducer assembly within the urethral balloon for final targeting prior to therapy delivery. Rotational beam plots indicate ϳ90°−100°acoustic output patterns from each 120°transducer sector, negligible coupling between sectors, and acoustic efficiencies between 41% and 53%. Experiments were performed within in vivo canine prostate ͑n =3͒, with real-time MR temperature monitoring in either the axial or coronal planes to facilitate control of the heating profiles and provide thermal dosimetry for performance assessment. Gross inspection of serial sections of treated prostate, exposed to TTC ͑triphenyl tetrazolium chloride͒ tissue viability stain, allowed for direct assessment of the extent of thermal coagulation. These devices created large contiguous thermal lesions ͑defined by 52°C maximum temperature, t 43 = 240 min thermal dose contours, and TTC tissue sections͒ that extended radially from the applicator toward the border of the prostate ͑ϳ15 mm͒ during a short power application ͑ϳ8−16 W per active sector, 8-15 min͒, with ϳ200°or 360°sector coagulation demonstrated depending upon the activation scheme. Analysis of transient temperature profiles indicated progression of lethal temperature and thermal dose contours initially centered on each sector that coalesced within ϳ5 min to produce uniform and contiguous zones of thermal destruction between sectors, with smooth outer boundaries and continued radial propagation in time. The dimension of the coagulation zone along the applicator was well-defined by positioning and active array length. Although not as precise as rotating planar and curvilinear devices currently under development for MR-guided procedures, advantages of these multi-sectored transurethral applicators include a flexible delivery catheter and that mechanical manipulation of the device using rotational motors is not required during therapy. This multi-sectored tubular array transurethral ultrasound technology has demonstrated potential for relatively fast and reasonably conformal targeting of prostate volumes suitable for the minimally invasive treatment of BPH and cancer under MR guidance, with further development warranted.

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“…The coagulated tissue resulting from thermal treatment is probably not well reabsorbed as has been seen in the literature on RF ablation of renal masses [12]. Deviation from the principle of immediate mechanical tissue debulking achieved with TURP is likely the reason for inferior long term outcomes, lengthy post-procedure catheterization requirements and delayed relief of symptoms [13, 14], when compared to TURP.…”

Section: Commentmentioning

confidence: 99%

Histotripsy of the Prostate: Dose Effects in a Chronic Canine Model

Hall

Hempel

Wojno

et al. 2009

Urology

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Objectives-This work aims to develop the technique of histotripsy ultrasound therapy as a noninvasive treatment for benign prostatic hyperplasia (BPH). We have previously demonstrated the feasibility of prostate histotripsy fractionation in a canine model. The purpose of this paper is to examine the histotripsy dose -tissue response effect over time to provide insight for treatment optimization.Methods-Various doses of histotripsy were applied trans-abdominally to the prostates of 20 canine subjects. Treated prostates were then harvested at interval time points from zero to 28 days and assessed for histologic treatment response.

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Efficacy of high-energy transurethral microwave thermotherapy in alleviating medically refractory urinary retention due to benign prostatic hyperplasia

Cited by 14 publications

References 12 publications

Transurethral microwave thermotherapy treatment of chronic urinary retention in patients unsuitable for surgery

Transurethral microwave thermotherapy treatment of chronic urinary retention in patients unsuitable for surgery

Transurethral ultrasound applicators with dynamic multi‐sector control for prostate thermal therapy: In vivo evaluation under MR guidance

Histotripsy of the Prostate: Dose Effects in a Chronic Canine Model

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