INTRAPROSTATIC TEMPERATURE MONITORING DURING TRANSURETHRAL MICROWAVE THERMOTHERAPY FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

Purpose: We evaluated whether the results of transurethral microwave t hermotherapy improve using high intraprostatic temperatures of 55C or greater. Materials and Methods: We accrued 30 men 58 to 85 years old ( mean age 69) from the waiting list for transurethral prostatic resecti on in whom maximum urinary flow was less than 13 mi. per second and Ma dsen score was greater than 8. According to the Abrams-Griffith nomogr am all but 1 patient had obstruction. Before treatment 3 thin temperat ure probes, each containing 5 sensors in a row, were introduced into t he prostate from the perineum and positioned using transurethral ultra sound guidance. The microwave power of the transurethral microwave the rmotherapy equipment was set based on the actual temperature in the pr ostatic tissue. A temperature of at least 55C and often more than 60C was reached at the hottest spot. Treatment duration was 1 hour. Postop eratively an indwelling catheter remained in place for 2 weeks. Patien ts were followed for 6 months with the first followup after 3 months. Results: At the S-month followup mean maximum urinary flow had increas ed from 7.4 to 12.5 mi. per second and the mean Madsen score had decre ased from 12.6 to 2.9. At the 6-month followup mean maximum urinary fl ow was 12.2 mi. per second and the mean Madsen score was 3.4. Using pr essure-flow data we divided the patients into responders and nonrespon ders. In the 18 responders maximum urinary flow had increased from 7.2 to 14.6 mi. per second (103%), the Madsen score had decreased from 12 .5 to 1.4 (89%) and detrusor pressure had decreased from 9.2 to 6 kPa. (35%). Conclusions: High energy transurethral microwave thermotherapy relieved bladder outlet obstruction in 60% of the patients and had a good effect on symptoms. Compared with a previous multicenter study wi th 40% responders, using the same criteria there were 60% responders i n our series. Our results indicate that better control of intraprostat ic temperature provides better results, approaching those after transu rethral prostatic resection.