STUDY OF THE EFFECTS OF THERMOTHERAPY IN BENIGN PROSTATIC HYPERTROPHY

Prostatic transurethral thermotherapy was evaluated clinically using t he Prostcare microwave system of the Bruker Company, which uses a micr owave radiometer to measure and control intraprostatic temperature. Ob jectives: The aim of our study was to evaluate the immediate histologi cal lesions induced in the prostatic tissue depending on the temperatu res delivered to the prostate; the histological changes when adenectom y is carried out after thermotherapy, and the endoscopic appearance of the prostatic fossa 48 h, and 1, 2, 3 and 6 months after thermotherap y. Methods: Our study was divided into three stages: in the first stag e, we conducted thermotherapy in 10 patients in whom suprapubic adenec tomy was indicated. During thermotherapy, a multipoint fiber-optic rec eptor and two thermocouples were implanted into the prostate gland at a distance of 5-15 mm from the urethra. Adenectomy was carried out 10 min after thermotherapy; the second stage of our study concerned the c hanges seen over time. We heated adenomas using the same protocol and carried out adenectomy 24, 48, 72 h, and 1 week, 6 weeks and 3 months after thermotherapy, and lastly, we studied the endoscopic appearance after a single heating-session of 30 min by endoscopic controls at dif ferent times after thermotherapy (48 h, 1, 2, 3 and 6 months after the rmotherapy). Results: Macroscopic appearance: necrotic lesions measure d 30 mm in length on average. Necrosis was roughly circumferential. Im mediate histological aspect: in all cases, histological examination sh owed coagulation necrosis with periurethral thromboses. Histological c hanges: at 8 days, necrosis intensity was maximal and histological str uctures were difficult to identify. Endoscopic appearance: 3 months af ter thermotherapy, the typical endoscopic appearance was a large periu rethral cavity. There was a sharp demarcation between untreated areas and cicatricial tissue. Conclusion: The efficacy of thermotherapy depe nds on the radiometric temperature, which should reach 47 degrees C (i .e. a temperature of 55-65 degrees C delivered to the prostate), and a rapid increase in temperature, i.e. in the power applied, which shoul d reach the thermal radiometric level of 47 degrees C in 5 min. As soo n as necrosis is obtained, the power is automatically reduced. Using t his protocol, heating proves effective in 30 min.