Transurethral hot-water balloon thermoablation for benign prostatic hyperplasia: Patient tolerance and pathologic findings

Objectives. To determine the patient tolerance and thermal ablation pattern in human prostatic tissue after treatment with a hot water, catheter-based system, Methods. Twenty-seven men scheduled for surgery for symptomatic benign pros tatic hyperplasia or adenocarcinoma of the prostate underwent water-induced thermotherapy. The patients were randomly assigned to one of four treatmen t groups. Lidocaine gel was the sole means of pain control. The patients an d an observer recorded patient discomfort during therapy. A Foley catheter was left in place until surgery (n = 13) or successful voiding (n = 14). Pr ostates were subsequently enucleated or removed, whole mounted, and examine d. Results. Patients reported mild treatment discomfort, the level of which di d not correlate with the extent of necrosis, balloon diameter, or water tem perature (all P > 0.05). Distal penile burning was the most commonly report ed discomfort. All 14 patients successfully voided within 12 days of treatm ent. Prostates were enucleated (n = 24) or removed (n = 3) at a mean of 27 days (range 4 to 120) after thermotherapy, except for a single adenectomy 1 7 months after therapy. Pathologic findings included periurethral hemorrhag ic necrosis, with focal or extensive urothelial denudation and mild inflamm ation. The mean maximal depth of necrosis from the urethral lumen was 7, 9, 10.33, and 11 mm in groups 1, 2, 3, and 4, respectively. The extent of nec rosis was similar in all groups (P = 0.11), regardless of the water tempera ture; conversely, the balloon diameter correlated with the depth of necrosi s (P = 0.024). Conclusions. This system of tissue ablation appears to be well tolerated, a nd it produced consistent pathologic results. UROLOGY 56: 76-81, 2000. (C) 2000, Elsevier Science Inc.