Microwave thermotherapy for benign prostatic hyperplasia

Hoffman, Richard M.; Monga, Manoj; Elliott, Sean P.; MacDonald, Roderick; Langsjoen, Jens; Tacklind, James; Wilt, Timothy J

doi:10.1002/14651858.cd004135.pub3

Cited by 56 publications

(45 citation statements)

References 52 publications

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“…Similarly, in their randomized study, Roehrborn et al [22] did not find any ejaculation or erectile problems in patients who had undergone the PUL procedure. Minimally invasive therapies including TUMT and TUNA are characterized by the increased risk of retrograde ejaculation (9.2-22.2%) and erectile dysfunction (0-18.2%) [25,26]. Many invasive treatment options that include TURP or PVP result in high rates of ejaculatory dysfunction (15-63%) and erectile dysfunction (14-26%) [26,27].…”

Section: Discussionmentioning

confidence: 99%

Prostatic Urethral Lift: A New Minimally Invasive Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

et al. 2015

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Introduction: Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTSs) secondary to benign prostatic hyperplasia (BPH). The PUL procedure involves the placement of implants that retract the obstructing prostate lobes. This procedure achieves quantifiable improvements in functional outcomes and quality of life (QoL), while preserving erectile and ejaculatory functions. Methods: Seventeen patients diagnosed with BPH who had undergone the UroLift® procedure between March 2011 and June 2015 were retrospectively evaluated. The parameters evaluated in the pre-operative, intra-operative and 1-year post-operative period were demographic data, and pre-operative, intra-operative and 1-year post-operative results were obtained from the International Prostate Symptom Score (IPSS), Uroflowmetry QoL index, International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire (MSHQ) for ejaculatory function (MSHQ-EjD). Results: The average improvements from baseline to 12 months after intervention were significant for the total IPSS 9.6. There was a 4.2-point increase in Qmax, a 0.9-point improvement in QoL and a 32% decrease in PVR. No statistically significant difference was found in the IIEF and MSHQ-EjD scores when the pre-operative and post-operative 3rd and 12th month scores were evaluated (p > 0.05). Conclusions: PUL offers rapid improvement in voiding and storage symptoms, QoL and flow rate that is durable to 12 months after intervention. PUL is a minimally invasive procedure that has the moderate effect in treating troublesome LUTS secondary to benign prostatic obstruction and preserving total sexual function.

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Section: Discussionmentioning

confidence: 99%

Prostatic Urethral Lift: A New Minimally Invasive Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

et al. 2015

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“…The median (interquartile range, IQR) IPSS was 19 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23) and QoL score was 3 (3)(4). All the implantations were successful, with no intraoperative complications recorded.…”

Section: Resultsmentioning

confidence: 90%

“…In addition, some Authors have reported that LUTS have a lower impact on QoL than sexual dysfunction or incontinence [1,[13][14][15]. To reduce the invasiveness of TURP, many minimally invasive surgical options have been proposed during recent decades (Table 4) [16][17][18][19][20][21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow‐up

et al. 2015

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ObjectivesTo report the first clinical experience with a temporary implantable nitinol device (TIND; Medi-Tate â ) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Patients and MethodsIn all, 32 patients with LUTS were enrolled in this prospective study, which was approved by our Institutional Ethics Committee. Inclusion criteria were: age >50 years, International Prostate Symptom Score (IPSS) of ≥10, maximum urinary flow rate (Q max ) of ≤12 mL/s, and prostate volume of <60 mL. The TIND was implanted within the bladder neck and the prostatic urethra under light sedation, using a rigid cystoscope. The device was removed 5 days later in an outpatient setting. Demographics, perioperative results, complications (according to the Clavien system), functional results and quality of life (QoL) were evaluated. Follow-up assessments were made at 3 and 6 weeks, and 3, 6 and 12 months postoperatively. The Student's t-test, analysis of variance (ANOVA), Kruskall-Wallis test, and simple and multiple linear regression models were used in the statistical analyses. ResultsThe mean patient age was 69.4 years, the mean (standard deviation, SD) prostate volume was 29.5 (7.4) mL and the Q max was 7.6 (2.2) mL/s. The median (interquartile range, IQR) IPSS was 19 (14-23) and QoL score was 3 (3-4). All the implantations were successful, with no intraoperative complications recorded. The mean operative time (SD) was 5.8 (2.5) min and the median (IQR) postoperative stay was 1 (1-2) day. All but one of the devices (96%) was removed 5 days at after implantation in an outpatient setting. Four complications (12.5%) were recorded, including urinary retention (one, 3.1%), transient incontinence due to device displacement (one, 3.1%), prostatic abscess (one, 3.1%), and urinary tract infection (one, 3.1%). Multiple regression analysis failed to identify any independent prognostic factor for complications. There were statistically significant differences in the IPSS, QoL score and Q max when comparing pre-and postoperative results at every time point. After 12 months, the median (IQR) IPSS and QoL score were 9 (7-13) and 1 (1-2), respectively, and the mean (SD) Q max was 12 (4.7) mL/s. The mean variations with respect to baseline conditions at the same time points were À45% for the IPSS and +67% for Q max . At 12 months after surgery (last followup visit), no patients required medical therapy or surgical procedures for BPH. ConclusionTIND implantation is a feasible and safe minimally invasive option for the treatment of BPH-related LUTS. The functional results are encouraging and the treatment significantly improved patient QoL. Further studies are required to assess durability of TIND results and to optimise the indications of such a procedure.

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“…We could not examine trends in the use of transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA) of the prostate, because the SASD and SID databases do not reliably capture these office based procedures. 6 However, TUMT and TUNA offer less durable results, 21,22 so a clinical decision for a patient with symptomatic LUTS first involves the decision for an operative versus office based procedure and then secondarily a decision for or against laser prostatectomy. Therefore, a comparison of laser prostatectomy and TURP more accurately reflects the real clinical decision-making process.…”

Section: Discussionmentioning

confidence: 99%

1974 Population Based Trends in the Surgical Treatment of Benign Prostatic Hyperplasia

Schroeck

Hollingsworth²,

Kaufman

et al. 2012

Journal of Urology

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Purpose-Laser prostatectomy has increased in popularity over the last decade. However, traditional transurethral resection of the prostate (TURP) remains common. In an effort to understand decisions surrounding use of laser prostatectomy versus TURP, we evaluated trends in transurethral surgery for benign prostatic hyperplasia (BPH) in an all payer dataset, focusing on patient and provider factors that are associated with receipt of laser prostatectomy. Methods-Using the State Inpatient and Ambulatory Surgery Databases for Florida, we identified subjects undergoing laser prostatectomy or TURP (2001 to 2009). We calculated rates of surgery over time, stratified by procedure type. We used multilevel regression to examine patient (age, race, level of comorbidity) and provider (surgeon volume) factors associated with receipt of laser prostatectomy versus TURP.Results-While the overall rates of transurethral surgery remained stable (p=0.227) over the study period, use of laser prostatectomy rose 400% (from 25 to 114 procedures per 100,000 men, p<0.001), replacing about half of all TURPs. Patients were less likely to undergo laser prostatectomy if they were older (OR 0.65, 95% CI 0.61-0.70) and less healthy (OR 0.48, 95% CI 0.45-0.51). While these factors were predictive of surgery type, the majority of the variation in laser prostatectomy use (69%) was explained by the urologist a patient saw.Conclusions-Laser prostatectomy utilization has increased over the last decade at the expense of TURP, driven largely by provider effects. However, the elderly and more infirm patients are the least likely to receive it, raising concerns about underuse in this population.

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Microwave thermotherapy for benign prostatic hyperplasia

Cited by 56 publications

References 52 publications

Prostatic Urethral Lift: A New Minimally Invasive Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

Prostatic Urethral Lift: A New Minimally Invasive Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow‐up

1974 Population Based Trends in the Surgical Treatment of Benign Prostatic Hyperplasia

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