Pressure-Flow Study Analyses in Patients Treated with High Energy Thermotherapy

Abstract

Purpose: We evaluated the urodynamic changes after high energy microwave thermotherapy in patients with lower urinary tract symptoms and benign prostatic enlargement.Materials and Methods: A total of 120 patients was available for analysis with urodynamic investigation and pressure-flow studies before and 6 months after treatment. Several obstruction parameters were used to evaluate treatment outcome.Results: A significant decrease (p <0.001) in all obstruction parameters was noted. Mean detrusor pressure at maximum flow decreased from 64.7 to 39.1 cm. water, urethral resistance factor from 41,8 to 23.5 cm. water and linear passive urethral resistance relation from 3.0 to 1.4. Analysis of subgroups showed better results in patients with greater degrees of obstruction.Conclusions: High energy thermotherapy results in a significant and substantial decrease in bladder outlet obstruction.

The predictive value of baseline variables in the treatment of benign prostatic hyperplasia using high‐energy transurethral microwave thermotherapy

“…For the response in linPURR, two variables (prostate volume and energy) predicted a good response, as the larger prostates should be able to absorb more energy. This is in accordance with other reports [ 5, 6, 10]. Overall, Table 4 clearly shows that higher energies result in a higher chance of having a good response in any one of the criteria.…”

“…Besides excellent short‐term results, the durability of response and safety should also be favourable. Studies with a 1‐year follow‐up showed a low rate of additional surgical interventions after high‐energy TUMT (HE‐TUMT) [ 3, 5–9]. Using the high‐energy software (Prostatron TM v. 2.5, EDAP Technomed, Lyon, France), recent results showed a low re‐treatment rate at 2 years of follow‐up, with persistent good symptomatic and objective responses [ 4].…”

“…Earlier studies with HE‐TUMT indicated that the size of the prostate and the grade of BOO were major predictive variables of treatment outcome [ 5, 6, 10]. In a previous study [ 11], stepwise logistic regression was used to construct a model including uroflow values, urodynamic variables, symptom scores, total TUMT energy, PSA level and patient age, which had a high predictive power for lack of response in the clinical evaluation criteria [ 12] at 26 weeks after treatment.…”

Transurethral resection of the prostate vs high‐energy thermotherapy of the prostate in patients with benign prostatic hyperplasia: long‐term results

“…Earlier studies suggest a better outcome after HE‐TUMT when treating more obstructed patients with larger prostates [ 5, 12, 16]. A recent study by d’Ancona et al .…”

“…This indicates that patients should not be selected on one baseline variable alone, but by a combination that should approximate the ideal patient profile, to provide the optimum therapy. Several recent studies show better results after HE‐TUMT, emphasizing the importance of the total amount of energy in treatment outcome [ 5–8, 13, 16, 18]. The number of patients who had a successful outcome, as defined by either a significant increase in Q max or a decrease in symptoms, was significantly greater among those in whom a higher temperature was achieved; in the present study, the total amount of energy delivered to the prostate was 152 kJ.…”