Temperature Controlled High Energy Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia Using a Heat Shock Strategy

Eliasson, Tomas; Damber, Jan‐Erik

doi:10.1097/00005392-199809010-00040

Cited by 8 publications

(18 citation statements)

References 9 publications

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“…Intravesical and abdominal pressures were measured with suprapubic intravesical and extravesical water-filled Detailed pretreatment evaluation, inclusion and exclusion criteria, treatment performance, follow-up Teflon catheters (inner diameter 1.0 mm, length 30 cm, Optinova AB, Godby, Finland) [16]. These catheters were procedures and the Prostcare device have been described previously in detail [12,13]. TUMT was performed on connected to pressure transducers (Ohmeda DTX@, Ohmeda, Singapore) via 75 cm long pressure-monitoring an outpatient single-session basis and no patients were admitted to hospital.…”

Section: Methodsmentioning

confidence: 99%

Pressure‐flow studies before and after transurethral microwave thermotherapy of benign prostatic hyperplasia using low‐ and high‐energy protocols

Eliasson

Damber

TeriÖ

1998

British Journal of Urology

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Objective To compare pressure-flow results before and 3Results There was a significantly greater improvement in pressure-flow variables, i.e. maximum urinary flow months after transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH), perrate, detrusor pressure at maximum flow and minimal urethral opening pressure, in those treated with higher formed with lower and higher energy protocols. Patients and methods Twenty-four patients were treated energy TUMT than in those receiving the lower energy protocol. The Madsen and quality-of-life scores, and using a high-energy protocol performed with a heatshock strategy, i.e. a rapid increase in intraprostatic maximum urinary flow rate on uroflowmetry, were also significantly better in the higher energy group. temperatures to a maximum of 55-67°C. A helical antenna was used which produced maximum heating Conclusion Higher energy TUMT performed using a heat-shock strategy provides a better pressure-flow at the base of the prostate. A further 25 patients were treated using a lower energy protocol with a slow outcome than lower energy thermotherapy. Compared with previously published results, the outcome after increase in intraprostatic temperatures to a maximum of 45-53°C. A first-generation filament antenna was higher energy TUMT is at least similar to other treatment alternatives for BPH. used with the maximum heat produced at the prostatic apex. All treatments were performed as single-session Keywords Prostatic hyperplasia, microwave thermotherapy, pressure-flow, higher energy outpatient procedures of 60-70 min duration.agreement that the only reliable way to diagnose and

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Section: Methodsmentioning

confidence: 99%

Pressure‐flow studies before and after transurethral microwave thermotherapy of benign prostatic hyperplasia using low‐ and high‐energy protocols

Eliasson

Damber

TeriÖ

1998

British Journal of Urology

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“…Thermotherapy with a quick rise in temperature (i.e., "heat shock") is more effective than slow heating, as the rapid rise in temperature (in 4 to 6 minutes) causes early vascular thrombosis and subsequent coagulation necrosis. 83 Also, the rapid rise in temperature precludes the inhibition of thermotherapy by vasodilatation and concomitant augmentation of the heat-sink effect. 76 Lastly, the treatment times are reduced using the heatshock approach.…”

Section: -82mentioning

confidence: 99%

Needle-Based Ablation of Renal Parenchyma Using Microwave, Cryoablation, Impedance- and Temperature-Based Monopolar and Bipolar Radiofrequency, and Liquid and Gel Chemoablation: Laboratory Studies and Review of the Literature

Rehman

Landman

Lee

et al. 2004

Journal of Endourology

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"Needle-based ablation of renal parenchyma using microwave, cryoablation, impedance-and temperature-based monopolar and bipolar radiofrequency, and liquid and gel chemoablation: Laboratory studies and review of the literature." Journal of Endourology.18,1. 83-104. (2004 ABSTRACTBackground and Purpose: Small renal tumors are often serendipitously detected during the screening of patients for renal or other disease entities. Rather than perform a radical or partial nephrectomy for these diminutive lesions, several centers have begun to explore a variety of ablative energy sources that could be applied directly via a percutaneously placed needle-like probe. To evaluate the utility of such treatment for small renal tumors/masses, we compared the feasibility, regularity (consistency in size and shape), and reproducibility of necrosis produced in normal porcine kidneys by different modes of tissue ablation: microwaves, cold impedance-based and temperature-based radiofrequency (RF) energy (monopolar and bipolar), and chemical. Chemoablation was accomplished using ethanol gel, hypertonic saline gel, and acetic acid gel either alone or with simultaneous application of monopolar or bipolar RF energy. Materials and Methods: A total of 107 renal lesions were created laparoscopically in 33 domestic pigs. Microwave thermoablation (N 5 12) was done using a Targis T3 (Urologix) 10F antenna. Cryoablation (N 5 16) was done using a single 1.5-mm probe or three 17F microprobes (17F SeedNet™ system; Galil Medical) (N 5 10 single probe and N 5 6 three probes); a double freeze cycle with a passive thaw was employed under ultrasound guidance. Dry RF lesions were created using custom-made 18-gauge single-needle monopolar probe with two or three exposed metal tips (GelTx) (N 5 12) or a single-needle bipolar probe (N 5 6) at 50 W of 510 kHz RF energy for 5 minutes. In addition, a multitine RF probe (RITA Medical Systems) was used in one set of studies (N 5 6). Both impedance-and temperature-based RF were evaluated. Chemoablation was performed with 95% ethanol (4 mL), 24% hypertonic saline (4 mL), and 50% acetic acid (4 mL) as single injections. In addition, chemoablation was tested with monopolar and bipolar RF (wet RF). Tissues were harvested 1 week after ablation for light microscopy.Results: In 11 of the 15 ablation techniques, there was complete necrosis in all lesions; however, three ethanol gel lesions had skip areas, three hypertonic saline gel lesions showed no necrosis or injury, and one monopolar RF and one bipolar RF lesion showed skip areas. In contrast to impedance-based RF, heat-based RF (RITA) caused complete necrosis without skip areas. All cryolesions resulted in complete tissue necrosis, and cryotherapy was the only modality for which lesion size could be effectively monitored using ultrasound imaging.

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“…The heat-shock strategy is characterized by a quick increase in power/temperatures that causes immediate vascular thromboses, resulting, theoretically, in similar or better clinical outcomes with a shorter treatment. 35 Temperature monitoring and heat distribution during thermotherapy are important parameters for optimal and tailored treatment. There is a relation between the intraprostatic temperature and the clinical results.…”

Section: External Microwave Thermotherapy 661mentioning

confidence: 99%

Application of External Microwave Thermotherapy in Urology: Past, Present, and Future

Gravas

Laguna

Rosette

2003

Journal of Endourology

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The excellent clinical results of transurethral microwave thermotherapy (TUMT) for the treatment of symptomatic benign prostatic hyperplasia (BPH) gave to TUMT the leading position among the microwave thermotherapy modalities available for the treatment of different urologic conditions. Research in TUMT has focused on operating software, temperature monitoring, intraprostatic heat distribution, cell-kill calculations, and correlations with clinical variables. Randomized comparisons of TUMT with other established therapies for BPH, including transurethral resection, have facilitated the evaluation of the clinical outcome, durability, morbidity, and costs of the treatment. The applications of microwave thermotherapy in other urologic diseases are also presented in this review.

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Temperature Controlled High Energy Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia Using a Heat Shock Strategy

Cited by 8 publications

References 9 publications

Pressure‐flow studies before and after transurethral microwave thermotherapy of benign prostatic hyperplasia using low‐ and high‐energy protocols

Pressure‐flow studies before and after transurethral microwave thermotherapy of benign prostatic hyperplasia using low‐ and high‐energy protocols

Needle-Based Ablation of Renal Parenchyma Using Microwave, Cryoablation, Impedance- and Temperature-Based Monopolar and Bipolar Radiofrequency, and Liquid and Gel Chemoablation: Laboratory Studies and Review of the Literature

Application of External Microwave Thermotherapy in Urology: Past, Present, and Future

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