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J.j.m.c.h. De La Rosette - One of the best experts on this subject based on the ideXlab platform.
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clinical efficacy of a new 30 min algorithm for transurethral Microwave Thermotherapy initial results
BJUI, 2007Co-Authors: J.j.m.c.h. De La Rosette, E A E Francisca, F M J Debruyne, D L Floratos, Barbara B M Kortmann, Lambertus A KiemeneyAbstract:Objective To assess the efficacy of a new 30-min algorithm for high-energy transurethral Microwave Thermotherapy (TUMT, Prostasoft 3.5) in the treatment of men with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia. Patients and methods A total of 108 men (mean age 66 years) with bothersome LUTS were treated with the new TUMT protocol. All patients were evaluated using a standard assessment at baseline, 6, 12, 26 and 52 weeks after TUMT. The evaluation included the assessment of objective and subjective outcome measures, with a urodynamic evaluation using pressure-flow analysis, and the occurrence of adverse events. Results The treatment was well tolerated. In general, the International Prostate Symptom Score improved from a mean of 20.0 at baseline to a mean of 9.3 at 6 months after treatment. The maximum urinary flow improved from 9.4 mL/s to 14.6 mL/s at 6 months. The mean duration of catheterization was 17.9 days. The urodynamic evaluation showed a change from the obstructed to the equivocal zone on the Abrams–Griffith nomogram. There were no serious complications. Urgency and frequency were the most frequent side-effects after treatment; these all resolved within 3 months. Conclusion High-energy TUMT using the new high-dose Prostasoft 3.5 protocol appears to be a safe and effective treatment. The faster procedure improves the tolerance of the treatment. The subjective and objective improvements were significant and the treatment-related morbidity low. A longer follow-up is needed to assess the durability of this new treatment protocol.
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transurethral resection vs Microwave Thermotherapy of the prostate a cost consequences analysis
BJUI, 2003Co-Authors: J.j.m.c.h. De La Rosette, F M J Debruyne, D L Floratos, Lambertus A Kiemeney, Johan L Severens, Pilar M LagunaAbstract:OBJECTIVE To compare the costs and outcome of high-energy transurethral Microwave Thermotherapy of the prostate (HE-TUMT) with transurethral resection of the prostate (TURP), as the former is considered to be the best minimally invasive method for managing lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Between January 1996 and March 1997, 144 patients were randomized to treatment with HE-TUMT (78) using the Prostatron device and Prostasoft 2.5 software (EDAP Technomed, Lyon, France), or TURP (66). At baseline and during the annual follow-up, patients were evaluated by the International Prostate Symptom Score and uroflowmetry (maximum flow rate and postvoid residual volume). Kaplan-Meier survival analyses were used to calculate the cumulative risk of re-treatment. A cost-consequences analysis was performed based on the prospective measurement of healthcare use, with costs expressed as Netherland guilders (NLG). RESULTS During a 3-year follow-up period, the mean (95% confidence interval) risk of re-treatment was 22.9 (12.5–33.2)% and 13.2 (4.5–21.9)% for HE-TUMT and TURP, respectively (P = 0.215). The mean direct cost of treatment was 3450 (3444–3456) and 6560 (5992–7128) NLG for HE-TUMT and TURP, respectively. The mean total (including re-treatments), discounted (4%) 3-year cost for the HE-TUMT and TURP group was 5300 (4692–5908) and 7800 (7118–8482) NLG, respectively. CONCLUSIONS In this prospective randomized trial, HE-TUMT and TURP had a comparable 3-year risk of re-treatment. Healthcare expenditure on HE-TUMT, mainly because it is an outpatient treatment, was significantly lower than for TURP.
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cell kill modeling of Microwave Thermotherapy for treatment of benign prostatic hyperplasia
Journal of Endourology, 2000Co-Authors: Magnus B Bolmsjö, Thayne R. Larson, Lennart Wagrell, Sonny Schelin, J.j.m.c.h. De La Rosette, Anders MattiassonAbstract:ABSTRACT Purpose: We investigated whether cell-kill modelling could be used as a mean for predicting the outcome of Microwave Thermotherapy for benign prostate hyperplasia (BPH). Methods: The two m...
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can histopathology predict treatment outcome following high energy transurethral Microwave Thermotherapy of the prostate results of a biopsy study
The Prostate, 1999Co-Authors: F C H Dancona, F M J Debruyne, Lambertus A Kiemeney, Y H M Albers, Y Xue, Frank Smedts, H G Van Der Poel, J.j.m.c.h. De La RosetteAbstract:BACKGROUND. Despite good results of high-energy transurethral Microwave Thermotherapy (TUMT) in the treatment of benign prostatic hyperplasia, it is still difficult to predict the response to treatment on an individual basis. Besides clinical baseline parameters, intrinsic histological parameters are suggested to play a role in the response variance after TUMT. In this study we analyzed histological parameters (vessel density and epithelium-stroma (E/S) ratio) in patients who were selected for high-energy TUMT and related these parameters to clinical outcome. METHODS. We treated 42 patients with high-energy TUMT, who prior to treatment agreed upon ultrasonographic investigation of the prostate in combination with biopsies of the peripheral and transitional zones of the prostate. For all separate biopsy locations, the histological stained prostate slides were morphometrically quantified with computer assistance and analyzed for E/S ratio and vessel density. Response to treatment was measured by using standardized response evaluation criteria and was correlated with histological outcome. RESULTS. The E/S ratio in the inner gland biopsies tended to be higher in the good response group compared to the very poor responders. Furthermore, a clear trend was seen towards a lower vessel density in good responders. Large prostates and prostates with a high E/S ratio responded well to the high-energy Thermotherapy. CONCLUSIONS. Histopathological parameters of the prostate tend to be moderately predictive for clinical response in this research population. Poor responders appeared to have a somewhat higher vessel density in all prostate biopsy sides, and there was also a trend towards a lower E/S ratio in these patients.
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results of high energy transurethral Microwave Thermotherapy in patients categorized according to the american society of anesthesiologists operative risk classification
Urology, 1999Co-Authors: F C H Dancona, E A E Francisca, F M J Debruyne, Lambertus A Kiemeney, A K Van Der Bij, H Kho, J.j.m.c.h. De La RosetteAbstract:Objectives. To evaluate the relation between the American Society of Anesthesiologists (ASA) classification and response to transurethral Microwave Thermotherapy (TUMT) in patients with lower urinary tract symptoms and benign prostatic hyperplasia (BPH). Methods. Two hundred forty-seven patients with symptomatic BPH treated with high-energy TUMT were scored retrospectively for ASA status. Student’s t test was used to determine differences in improvement at each point of follow-up between patients classified as ASA 1 or 2 and patients classified as ASA 3 or 4. Logistic regression analysis was performed to assess the predictive value of ASA status for response using the World Health Organization response evaluation criteria for International Prostate Symptom Score, maximal flow rate, and urodynamic obstruction. Results. There was a significant improvement in objective and subjective parameters at 12, 26, and 52 weeks of follow-up in both ASA 1 and 2 patients and ASA 3 and 4 patients. There was no difference in objective and subjective improvement between both groups at each point of follow-up. Objective and subjective improvement in ASA 3 and 4 patients with cardiovascular disease and ASA 3 and 4 patients with noncardiovascular disease was the same, although patients with cardiovascular disease received less energy during TUMT. Using logistic regression analysis, ASA classification was not predictive of response after high-energy TUMT. Conclusions. There is no relation between ASA classification and outcome after high-energy TUMT. Because these patients are considered at high risk of perioperative complications and postoperative morbidity, TUMT could contribute considerably to the treatment of BPH in this specific group of patients.
Michael Marberger - One of the best experts on this subject based on the ideXlab platform.
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targeted transurethral Microwave Thermotherapy versus alpha blockade in benign prostatic hyperplasia outcomes at 18 months
Urology, 2001Co-Authors: Bob Djavan, Claus G Roehrborn, Ali Basharkhah, Christian Seitz, Mesut Remzi, Mitra Fakhari, Matthias Waldert, Bernhard Planz, Mike Harik, Michael MarbergerAbstract:Abstract Objectives. To compare directly the efficacy, safety, and durability of targeted transurethral Microwave Thermotherapy with that of alpha-blocker treatment for lower urinary tract symptoms of benign prostatic hyperplasia. Methods. In a randomized, controlled clinical trial, 52 patients with lower urinary tract symptoms due to benign prostatic hyperplasia received terazosin treatment and 51 underwent Microwave treatment under topical anesthesia. The patient evaluation included the International Prostate Symptom Score, peak flow rate, and quality-of-life score before Microwave treatment or initiation of terazosin treatment and at periodic intervals thereafter up to 18 months. Results. The mean International Prostate Symptom Score, peak flow rate, and quality-of-life score all improved significantly in both groups by 6 months. However, the magnitude of improvement was significantly greater in the Microwave group than in the terazosin group. The significant between-group differences observed at 6 months in the mean International Prostate Symptom Score, peak flow rate, and quality-of-life score were fully maintained at 18 months, at which time the improvements in these three outcome measures were significantly greater ( P Conclusions. Although the initial onset of terazosin action was more rapid, the longer term clinical outcomes of targeted Microwave treatment were markedly superior. The more favorable results in patients who underwent Microwave treatment were maintained for at least 18 months.
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pretreatment prostate specific antigen as an outcome predictor of targeted transurethral Microwave Thermotherapy
Urology, 2000Co-Authors: Bob Djavan, Keywan Ghawidel, Bernd Bursa, Ali Basharkhah, Christian Seitz, Mesut Remzi, Stephan Hruby, Michael MarbergerAbstract:Abstract Objectives. To evaluate pretreatment serum prostate-specific antigen (PSA) as an outcome predictor of targeted Microwave Thermotherapy. Methods. Seventy-one patients with lower urinary tract symptoms of benign prostatic hyperplasia underwent targeted transurethral Microwave Thermotherapy using the Targis system. Outcomes 12 months after treatment were evaluated by the International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and quality-of-life (QOL) score. The ability of PSA to predict outcomes was evaluated by linear and logistic regression and receiver operating characteristic curve analysis. Results. Higher pretreatment PSA levels were significantly predictive of an absolute IPSS change of −7.5 or less for patients with moderate baseline symptoms or −15 or less for those with severe baseline symptoms; an absolute Qmax change of 5 mL/s or greater; an absolute QOL score change of −3 or less; an IPSS at 12 months of 7 or less; a Qmax at 12 months of greater than 12 mL/s; and a QOL score at 12 months of 1 or less. Nevertheless, even without taking pretreatment PSA into account, most patients benefitted substantially from targeted Microwave Thermotherapy. Thus, 74%, 71%, and 79% of all eligible patients improved 50% or more in IPSS, Qmax, and QOL score, respectively, at 12 months compared with baseline. No significant association between PSA and either prostate or transition zone volume could be demonstrated. Conclusions. Most patients benefit substantially from targeted Microwave Thermotherapy. However, higher PSA levels are significantly predictive of more favorable outcomes. This association may reflect patient-to-patient differences in the relative abundance of PSA-producing epithelial cells in the transition zone of the prostate.
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high energy transurethral Microwave Thermotherapy in patients with acute urinary retention due to benign prostatic hyperplasia
Urology, 1999Co-Authors: Bob Djavan, Keywan Ghawidel, Bernd Bursa, Ali Basharkhah, Christian Seitz, Stephan Hruby, Michael MarbergerAbstract:Objectives. To evaluate the efficacy and safety of targeted high-energy transurethral Microwave Thermotherapy (HE-TUMT) in the treatment of acute urinary retention (AUR) due to benign prostatic hyperplasia (BPH). Methods. In this prospective cohort study, 31 patients with painful AUR due to BPH underwent HE-TUMT. Patient evaluation before treatment and during a 12-week follow-up interval included determination of International Prostate Symptom Score (IPSS), quality of life (QOL) score, peak flow rate (Qmax) by uroflowmetry, and postvoid residual urine. Patients also underwent urodynamic evaluation before treatment and at 16 weeks. Results. By 4 weeks after HE-TUMT, 29 (94%) of 31 patients had regained the ability to void spontaneously. The actuarial median time for restoration of spontaneous voiding was 3.0 weeks (95% confidence interval [CI] 2.2 to 3.8). At 12 weeks, the mean IPSS (9.4; 95% CI 8.3 to 10.5) was 50% below (P <0.0005) that before retention (18.9; 95% CI 18.2 to 19.6). Improvements in the mean QOL score were similar in pattern and relative magnitude to those in the mean IPSS. A 69% increase in mean Qmax (P <0.0005) determined by uroflowmetry was observed by 12 weeks versus 1 week after HE-TUMT. Complications were infrequent. Conclusions. This study provides preliminary evidence that HE-TUMT may potentially afford a novel and useful option for the patient with AUR who is not a suitable candidate for surgery.
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neoadjuvant and adjuvant alpha blockade improves early results of high energy transurethral Microwave Thermotherapy for lower urinary tract symptoms of benign prostatic hyperplasia a randomized prospective clinical trial
Urology, 1999Co-Authors: Bob Djavan, Claus G Roehrborn, Shahrokh F Shariat, Keywan Ghawidel, Christian Seitz, Mitra Fakhari, Alan W Partin, Michael MarbergerAbstract:Objectives. Improved long-term results with respect to symptoms, voiding function, and quality of life (QOL) in patients with lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH) are achieved with targeted high-energy transurethral Microwave Thermotherapy (TUMT) compared with alpha-blocker treatment alone. However, maximal improvement after TUMT is not attained until 3 to 6 months after treatment. Measures to provide earlier symptom relief and improved voiding function and QOL would add to the clinical utility of TUMT. The objective of the present study was to determine whether neoadjuvant and adjuvant alpha-blockade is capable of accelerating a post-TUMT decrease in LUTS of patients with BPH. Methods. In this randomized, prospective study of 81 patients with LUTS of BPH, 41 underwent TUMT with neoadjuvant and adjuvant tamsulosin (0.4 mg daily) treatment, and 40 had TUMT alone. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and QOL score were determined before treatment and at periodic intervals thereafter up to 12 weeks after TUMT. Results. Mean IPSS values in the TUMT plus tamsulosin group at 2 weeks (14.0, 95% confidence interval [CI] 13.1 to 14.9) and 6 weeks (8.6; 95% CI 7.7 to 9.5) were 15% and 24% lower, respectively, than those at 2 weeks (16.5, 95% CI 15.6 to 17.4) and 6 weeks (11.3, 95% CI 10.4 to 12.2) in the TUMT-alone group (P < 0.0005). However, by the final evaluation at 12 weeks, no significant difference between the groups in mean IPSS was evident. A similar temporal pattern of difference between the two study groups was also observed in QOL score. No significant between-group difference in mean Qmax was evident after TUMT. Urinary retention 1 week or more in duration occurred in 5 (12%) of 40 TUMT-alone group patients compared with 1 (2%) of 41 TUMT plus tamsulosin group patients. Conclusions. Neoadjuvant and adjuvant alpha-blocker treatment results in significantly greater early symptom reduction and QOL score improvement after TUMT, adding to the clinical utility of this minimally invasive treatment modality. In addition, post-TUMT complications such as urinary retention may be reduced.
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prospective randomized comparison of high energy transurethral Microwave Thermotherapy versus alpha blocker treatment of patients with benign prostatic hyperplasia
The Journal of Urology, 1999Co-Authors: Bob Djavan, Claus G Roehrborn, Shahrokh F Shariat, Keywan Ghawidel, Michael MarbergerAbstract:AbstractPurpose: We compare directly the efficacy and safety of targeted high energy transurethral Microwave Thermotherapy with alpha-blocker treatment for benign prostatic hyperplasia (BPH).Materials and Methods: In this randomized prospective study 52 patients with symptomatic BPH received terazosin and 51 underwent high energy transurethral Microwave therapy with topical anesthesia. Patient evaluation included determination of International Prostate Symptom Score (I-PSS), peak flow rate and quality of life score before transurethral Microwave therapy or terazosin and periodically up to 6 months thereafter.Results: At 2-week followup the terazosin group transiently exhibited significantly greater improvement than the transurethral Microwave therapy group in mean values of all 3 primary efficacy parameters of I-PSS, peak flow rate and quality of life score. At 12 weeks and 6 months this pattern was reversed, and the transurethral Microwave therapy group achieved significantly greater improvement than the...
F M J Debruyne - One of the best experts on this subject based on the ideXlab platform.
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clinical efficacy of a new 30 min algorithm for transurethral Microwave Thermotherapy initial results
BJUI, 2007Co-Authors: J.j.m.c.h. De La Rosette, E A E Francisca, F M J Debruyne, D L Floratos, Barbara B M Kortmann, Lambertus A KiemeneyAbstract:Objective To assess the efficacy of a new 30-min algorithm for high-energy transurethral Microwave Thermotherapy (TUMT, Prostasoft 3.5) in the treatment of men with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia. Patients and methods A total of 108 men (mean age 66 years) with bothersome LUTS were treated with the new TUMT protocol. All patients were evaluated using a standard assessment at baseline, 6, 12, 26 and 52 weeks after TUMT. The evaluation included the assessment of objective and subjective outcome measures, with a urodynamic evaluation using pressure-flow analysis, and the occurrence of adverse events. Results The treatment was well tolerated. In general, the International Prostate Symptom Score improved from a mean of 20.0 at baseline to a mean of 9.3 at 6 months after treatment. The maximum urinary flow improved from 9.4 mL/s to 14.6 mL/s at 6 months. The mean duration of catheterization was 17.9 days. The urodynamic evaluation showed a change from the obstructed to the equivocal zone on the Abrams–Griffith nomogram. There were no serious complications. Urgency and frequency were the most frequent side-effects after treatment; these all resolved within 3 months. Conclusion High-energy TUMT using the new high-dose Prostasoft 3.5 protocol appears to be a safe and effective treatment. The faster procedure improves the tolerance of the treatment. The subjective and objective improvements were significant and the treatment-related morbidity low. A longer follow-up is needed to assess the durability of this new treatment protocol.
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transurethral resection vs Microwave Thermotherapy of the prostate a cost consequences analysis
BJUI, 2003Co-Authors: J.j.m.c.h. De La Rosette, F M J Debruyne, D L Floratos, Lambertus A Kiemeney, Johan L Severens, Pilar M LagunaAbstract:OBJECTIVE To compare the costs and outcome of high-energy transurethral Microwave Thermotherapy of the prostate (HE-TUMT) with transurethral resection of the prostate (TURP), as the former is considered to be the best minimally invasive method for managing lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Between January 1996 and March 1997, 144 patients were randomized to treatment with HE-TUMT (78) using the Prostatron device and Prostasoft 2.5 software (EDAP Technomed, Lyon, France), or TURP (66). At baseline and during the annual follow-up, patients were evaluated by the International Prostate Symptom Score and uroflowmetry (maximum flow rate and postvoid residual volume). Kaplan-Meier survival analyses were used to calculate the cumulative risk of re-treatment. A cost-consequences analysis was performed based on the prospective measurement of healthcare use, with costs expressed as Netherland guilders (NLG). RESULTS During a 3-year follow-up period, the mean (95% confidence interval) risk of re-treatment was 22.9 (12.5–33.2)% and 13.2 (4.5–21.9)% for HE-TUMT and TURP, respectively (P = 0.215). The mean direct cost of treatment was 3450 (3444–3456) and 6560 (5992–7128) NLG for HE-TUMT and TURP, respectively. The mean total (including re-treatments), discounted (4%) 3-year cost for the HE-TUMT and TURP group was 5300 (4692–5908) and 7800 (7118–8482) NLG, respectively. CONCLUSIONS In this prospective randomized trial, HE-TUMT and TURP had a comparable 3-year risk of re-treatment. Healthcare expenditure on HE-TUMT, mainly because it is an outpatient treatment, was significantly lower than for TURP.
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long term followup of randomized transurethral Microwave Thermotherapy versus transurethral prostatic resection study
The Journal of Urology, 2001Co-Authors: D L Floratos, F M J Debruyne, Lambertus A Kiemeney, Cristina Rossi, Barbara B M Kortmann, Jean J.m.c.h. De La RosetteAbstract:Purpose: We evaluate the durable effect of high-energy transurethral Microwave Thermotherapy and transurethral prostatic resection for treatment of patients with lower urinary tract symptoms suggestive of bladder outflow obstruction.Materials and Methods: Between January 1996 and March 1997, 155 patients with lower urinary tract symptoms suggestive of bladder outflow obstruction were randomized to receive transurethral Microwave Thermotherapy (Prostatron * *EDAP Technomed, Lyon, France.; device and commercial software) (82) or undergo transurethral prostatic resection (73). Initial patient evaluation was performed according to international standards. Patients were followed annually with the International Prostate Symptom Score (I-PSS) and uroflowmetry (maximum flow rate). The Kaplan-Meier survival analysis was used to calculate the cumulative risk of re-treatment, adjusted for loss to followup.Results: A total of 78 patients received transurethral Microwave Thermotherapy and 66 underwent transurethral pr...
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high energy transurethral Microwave Thermotherapy for the treatment of patients in urinary retention
The Journal of Urology, 2000Co-Authors: D L Floratos, E A E Francisca, F M J Debruyne, Lambertus A Kiemeney, Barbara B M Kortmann, Gabe S Sonke, Jean J.m.c.h. De La RosetteAbstract:Purpose:: We evaluated the efficacy of high energy transurethral Microwave Thermotherapy for treating urinary retention due to benign prostatic hyperplasia.Materials and Methods:: Between October 1993 and March 1999, 41 patients with urinary retention were treated with high energy transurethral Microwave Thermotherapy. Initial evaluation consisted of a history, clinical examination, urethrocystoscopy, transrectal prostate ultrasonography and urodynamic investigation with a pressure flow study. Followup visits at 12, 26 and 52 weeks included International Prostate Symptom Score (I-PSS), uroflowmetry and post-void residual urine volume determination. At 26 weeks the urodynamic study was repeated. Kaplan-Meier plots were constructed to evaluate the risk of re-treatment adjusted for patients lost to followup.Results:: At baseline median patient age was 74 years and median prostate size was 67 ml. Median 133 kJ. were administered. Nine patients underwent re-treatment and 11 were lost to followup. The re-treatm...
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can histopathology predict treatment outcome following high energy transurethral Microwave Thermotherapy of the prostate results of a biopsy study
The Prostate, 1999Co-Authors: F C H Dancona, F M J Debruyne, Lambertus A Kiemeney, Y H M Albers, Y Xue, Frank Smedts, H G Van Der Poel, J.j.m.c.h. De La RosetteAbstract:BACKGROUND. Despite good results of high-energy transurethral Microwave Thermotherapy (TUMT) in the treatment of benign prostatic hyperplasia, it is still difficult to predict the response to treatment on an individual basis. Besides clinical baseline parameters, intrinsic histological parameters are suggested to play a role in the response variance after TUMT. In this study we analyzed histological parameters (vessel density and epithelium-stroma (E/S) ratio) in patients who were selected for high-energy TUMT and related these parameters to clinical outcome. METHODS. We treated 42 patients with high-energy TUMT, who prior to treatment agreed upon ultrasonographic investigation of the prostate in combination with biopsies of the peripheral and transitional zones of the prostate. For all separate biopsy locations, the histological stained prostate slides were morphometrically quantified with computer assistance and analyzed for E/S ratio and vessel density. Response to treatment was measured by using standardized response evaluation criteria and was correlated with histological outcome. RESULTS. The E/S ratio in the inner gland biopsies tended to be higher in the good response group compared to the very poor responders. Furthermore, a clear trend was seen towards a lower vessel density in good responders. Large prostates and prostates with a high E/S ratio responded well to the high-energy Thermotherapy. CONCLUSIONS. Histopathological parameters of the prostate tend to be moderately predictive for clinical response in this research population. Poor responders appeared to have a somewhat higher vessel density in all prostate biopsy sides, and there was also a trend towards a lower E/S ratio in these patients.
Bob Djavan - One of the best experts on this subject based on the ideXlab platform.
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targeted transurethral Microwave Thermotherapy versus alpha blockade in benign prostatic hyperplasia outcomes at 18 months
Urology, 2001Co-Authors: Bob Djavan, Claus G Roehrborn, Ali Basharkhah, Christian Seitz, Mesut Remzi, Mitra Fakhari, Matthias Waldert, Bernhard Planz, Mike Harik, Michael MarbergerAbstract:Abstract Objectives. To compare directly the efficacy, safety, and durability of targeted transurethral Microwave Thermotherapy with that of alpha-blocker treatment for lower urinary tract symptoms of benign prostatic hyperplasia. Methods. In a randomized, controlled clinical trial, 52 patients with lower urinary tract symptoms due to benign prostatic hyperplasia received terazosin treatment and 51 underwent Microwave treatment under topical anesthesia. The patient evaluation included the International Prostate Symptom Score, peak flow rate, and quality-of-life score before Microwave treatment or initiation of terazosin treatment and at periodic intervals thereafter up to 18 months. Results. The mean International Prostate Symptom Score, peak flow rate, and quality-of-life score all improved significantly in both groups by 6 months. However, the magnitude of improvement was significantly greater in the Microwave group than in the terazosin group. The significant between-group differences observed at 6 months in the mean International Prostate Symptom Score, peak flow rate, and quality-of-life score were fully maintained at 18 months, at which time the improvements in these three outcome measures were significantly greater ( P Conclusions. Although the initial onset of terazosin action was more rapid, the longer term clinical outcomes of targeted Microwave treatment were markedly superior. The more favorable results in patients who underwent Microwave treatment were maintained for at least 18 months.
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pretreatment prostate specific antigen as an outcome predictor of targeted transurethral Microwave Thermotherapy
Urology, 2000Co-Authors: Bob Djavan, Keywan Ghawidel, Bernd Bursa, Ali Basharkhah, Christian Seitz, Mesut Remzi, Stephan Hruby, Michael MarbergerAbstract:Abstract Objectives. To evaluate pretreatment serum prostate-specific antigen (PSA) as an outcome predictor of targeted Microwave Thermotherapy. Methods. Seventy-one patients with lower urinary tract symptoms of benign prostatic hyperplasia underwent targeted transurethral Microwave Thermotherapy using the Targis system. Outcomes 12 months after treatment were evaluated by the International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and quality-of-life (QOL) score. The ability of PSA to predict outcomes was evaluated by linear and logistic regression and receiver operating characteristic curve analysis. Results. Higher pretreatment PSA levels were significantly predictive of an absolute IPSS change of −7.5 or less for patients with moderate baseline symptoms or −15 or less for those with severe baseline symptoms; an absolute Qmax change of 5 mL/s or greater; an absolute QOL score change of −3 or less; an IPSS at 12 months of 7 or less; a Qmax at 12 months of greater than 12 mL/s; and a QOL score at 12 months of 1 or less. Nevertheless, even without taking pretreatment PSA into account, most patients benefitted substantially from targeted Microwave Thermotherapy. Thus, 74%, 71%, and 79% of all eligible patients improved 50% or more in IPSS, Qmax, and QOL score, respectively, at 12 months compared with baseline. No significant association between PSA and either prostate or transition zone volume could be demonstrated. Conclusions. Most patients benefit substantially from targeted Microwave Thermotherapy. However, higher PSA levels are significantly predictive of more favorable outcomes. This association may reflect patient-to-patient differences in the relative abundance of PSA-producing epithelial cells in the transition zone of the prostate.
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high energy transurethral Microwave Thermotherapy in patients with acute urinary retention due to benign prostatic hyperplasia
Urology, 1999Co-Authors: Bob Djavan, Keywan Ghawidel, Bernd Bursa, Ali Basharkhah, Christian Seitz, Stephan Hruby, Michael MarbergerAbstract:Objectives. To evaluate the efficacy and safety of targeted high-energy transurethral Microwave Thermotherapy (HE-TUMT) in the treatment of acute urinary retention (AUR) due to benign prostatic hyperplasia (BPH). Methods. In this prospective cohort study, 31 patients with painful AUR due to BPH underwent HE-TUMT. Patient evaluation before treatment and during a 12-week follow-up interval included determination of International Prostate Symptom Score (IPSS), quality of life (QOL) score, peak flow rate (Qmax) by uroflowmetry, and postvoid residual urine. Patients also underwent urodynamic evaluation before treatment and at 16 weeks. Results. By 4 weeks after HE-TUMT, 29 (94%) of 31 patients had regained the ability to void spontaneously. The actuarial median time for restoration of spontaneous voiding was 3.0 weeks (95% confidence interval [CI] 2.2 to 3.8). At 12 weeks, the mean IPSS (9.4; 95% CI 8.3 to 10.5) was 50% below (P <0.0005) that before retention (18.9; 95% CI 18.2 to 19.6). Improvements in the mean QOL score were similar in pattern and relative magnitude to those in the mean IPSS. A 69% increase in mean Qmax (P <0.0005) determined by uroflowmetry was observed by 12 weeks versus 1 week after HE-TUMT. Complications were infrequent. Conclusions. This study provides preliminary evidence that HE-TUMT may potentially afford a novel and useful option for the patient with AUR who is not a suitable candidate for surgery.
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neoadjuvant and adjuvant alpha blockade improves early results of high energy transurethral Microwave Thermotherapy for lower urinary tract symptoms of benign prostatic hyperplasia a randomized prospective clinical trial
Urology, 1999Co-Authors: Bob Djavan, Claus G Roehrborn, Shahrokh F Shariat, Keywan Ghawidel, Christian Seitz, Mitra Fakhari, Alan W Partin, Michael MarbergerAbstract:Objectives. Improved long-term results with respect to symptoms, voiding function, and quality of life (QOL) in patients with lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH) are achieved with targeted high-energy transurethral Microwave Thermotherapy (TUMT) compared with alpha-blocker treatment alone. However, maximal improvement after TUMT is not attained until 3 to 6 months after treatment. Measures to provide earlier symptom relief and improved voiding function and QOL would add to the clinical utility of TUMT. The objective of the present study was to determine whether neoadjuvant and adjuvant alpha-blockade is capable of accelerating a post-TUMT decrease in LUTS of patients with BPH. Methods. In this randomized, prospective study of 81 patients with LUTS of BPH, 41 underwent TUMT with neoadjuvant and adjuvant tamsulosin (0.4 mg daily) treatment, and 40 had TUMT alone. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and QOL score were determined before treatment and at periodic intervals thereafter up to 12 weeks after TUMT. Results. Mean IPSS values in the TUMT plus tamsulosin group at 2 weeks (14.0, 95% confidence interval [CI] 13.1 to 14.9) and 6 weeks (8.6; 95% CI 7.7 to 9.5) were 15% and 24% lower, respectively, than those at 2 weeks (16.5, 95% CI 15.6 to 17.4) and 6 weeks (11.3, 95% CI 10.4 to 12.2) in the TUMT-alone group (P < 0.0005). However, by the final evaluation at 12 weeks, no significant difference between the groups in mean IPSS was evident. A similar temporal pattern of difference between the two study groups was also observed in QOL score. No significant between-group difference in mean Qmax was evident after TUMT. Urinary retention 1 week or more in duration occurred in 5 (12%) of 40 TUMT-alone group patients compared with 1 (2%) of 41 TUMT plus tamsulosin group patients. Conclusions. Neoadjuvant and adjuvant alpha-blocker treatment results in significantly greater early symptom reduction and QOL score improvement after TUMT, adding to the clinical utility of this minimally invasive treatment modality. In addition, post-TUMT complications such as urinary retention may be reduced.
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prospective randomized comparison of high energy transurethral Microwave Thermotherapy versus alpha blocker treatment of patients with benign prostatic hyperplasia
The Journal of Urology, 1999Co-Authors: Bob Djavan, Claus G Roehrborn, Shahrokh F Shariat, Keywan Ghawidel, Michael MarbergerAbstract:AbstractPurpose: We compare directly the efficacy and safety of targeted high energy transurethral Microwave Thermotherapy with alpha-blocker treatment for benign prostatic hyperplasia (BPH).Materials and Methods: In this randomized prospective study 52 patients with symptomatic BPH received terazosin and 51 underwent high energy transurethral Microwave therapy with topical anesthesia. Patient evaluation included determination of International Prostate Symptom Score (I-PSS), peak flow rate and quality of life score before transurethral Microwave therapy or terazosin and periodically up to 6 months thereafter.Results: At 2-week followup the terazosin group transiently exhibited significantly greater improvement than the transurethral Microwave therapy group in mean values of all 3 primary efficacy parameters of I-PSS, peak flow rate and quality of life score. At 12 weeks and 6 months this pattern was reversed, and the transurethral Microwave therapy group achieved significantly greater improvement than the...
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Evaluation of Microwave Thermotherapy With Histopathology, Magnetic Resonance Imaging and Temperature Mapping
Journal of Urology, 2004Co-Authors: Christian Huidobro, Thayne R. Larson, Magnus B Bolmsjö, Jean J.m.c.h. De La Rosette, Lennart Wagrell, Sonny Schelin, Tomasz Gorecki, Anders MattiassonAbstract:ABSTRACTPurpose: Interstitial temperature mapping was used to determine the heat field within the prostate by the Coretherm (ProstaLund, Lund, Sweden) transurethral Microwave Thermotherapy device. Gadolinium enhanced magnetic resonance imaging (MRI) and histopathology were used to determine the extent and pattern of coagulation necrosis following treatment. The cell kill assessment feature of the device was compared with MRI and histopathology.Materials and Methods: A total of 12 patients were treated, including 5 with adenocarcinoma of the prostate and 7 with benign prostatic hyperplasia. Temperature sensors were inserted from the perineum to map the temperature distribution. The 5 patients with adenocarcinoma underwent prostatectomy and subsequent histopathology 3 to 6 weeks after treatment. MRI and cell kill calculations were performed in all patients.Results: Therapeutic temperatures were found in a bowl-like shape with a wide circumference of highest temperatures at the base of the prostate, and decr...
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efficacy and safety of intraprostatic temperature controlled Microwave Thermotherapy in patients with benign prostatic hyperplasia results of a prospective open label single center study with 1 year follow up
Journal of Endourology, 2003Co-Authors: Stavros Gravas, M P Laguna, Jean J.m.c.h. De La RosetteAbstract:Background and Purpose: Different devices for transurethral Microwave Thermotherapy (TUMT) are currently available for the treatment of benign prostatic hyperplasia (BPH). We evaluated the efficacy and safety of the Prostalund Feedback Treatment® (PLFT®), which continuously records the intraprostatic temperature, and its impact on sexual function of the patients. Patients and Methods: A total of 41 patients with lower urinary tract symptoms attributed to BPH were entered in this prospective open-label, single-center study of PLFT. The initial evaluation was performed according to a standard protocol. At 3, 6, and 12 months, the International Prostate Symptom Score (IPSS), bother score, sexual function, and peak flow rate (Qmax) were recorded. In addition, determination of prostate volume by transrectal ultrasonography (TRUS) and measurement of residual urine volume were repeated at the 6- and 12-month visits. All adverse events were also recorded. Patients with IPSS of ≤7, ≥50% improvement in IPSS from ba...
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transurethral Microwave Thermotherapy the gold standard for minimally invasive therapies for patients with benign prostatic hyperplasia
Journal of Endourology, 2003Co-Authors: Jean J.m.c.h. De La Rosette, Pilar M Laguna, Stavros Gravas, Michel J A M De WildtAbstract:From all available minimally invasive methods for the treatment of symptomatic benign prostatic hyperplasia (BPH), transurethral Microwave Thermotherapy (TUMT) has gained a firm position as the most attractive option. Recent research has produced innovations in high-energy TUMT, including new treatment protocols, refined selection criteria, and monitoring of intraprostatic temperature. Furthermore, long-term results from randomized studies comparing TUMT with transurethral resection of the prostate (TURP) or medical treatment are now available. All these data indicate that more durable clinical outcomes and less morbidity can be achieved with TUMT, strengthening its position as a standard treatment for BPH. This paper describes the status of TUMT in the treatment of lower urinary tract symptoms related to BPH, focusing on variations in the outcomes with different devices, the durability of treatment outcomes, morbidity, selection criteria, and cost. The relation of TUMT to medical management and TURP also is addressed.
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quantification of prostate shrinkage after Microwave Thermotherapy a comparison of calculated cell kill versus 3d transrectal ultrasound planimetry
European Urology, 2003Co-Authors: Aswin L Hoffmann, Jean J.m.c.h. De La Rosette, Pilar M Laguna, Hessel WijkstraAbstract:Abstract Purpose: To compare prostate shrinkage after transurethral Microwave Thermotherapy (TUMT) with calculated cell-kill. Materials and Methods: The calculated cell-kill from 33 males with benign prostatic hyperplasia (BPH) treated with TUMT according to the ProstaLund Feedback Treatment™ (PLFT) method was compared to the post-treatment prostate volume change. The prostate volume was estimated with three-dimensional transrectal ultrasound (3D-TRUS) planimetry at baseline, 3, 6, and 12 months follow-up. A paired t -test was used to test the statistical significance of differences between the cell-kill volume and the prostate volume change. Linear regression was used to infer a relationship between the cell-kill and the 3D-TRUS data. The reproducibility of the 3D-TRUS method was assessed in repeated measurements. Results: The mean prostate volume at baseline ( N =33) was 56.1 cm 3 . After 3 ( N =25), 6 ( N =29) and 12 months ( N =23), it was 45.5 cm 3 , 39.7 cm 3 , and 45.1 cm 3 , respectively. The corresponding average cell-kill volume was 16.4 cm 3 , 17.1 cm 3 , and 17.2 cm 3 , respectively. Predicted cell-kill volume was significantly larger than prostate shrinkage at 3 ( p p =0.0002), and 12 months ( p r =0.74, p r =0.57, p =0.0041). Examination and investigation variability both averaged 2.5%. Conclusions: Cell-kill calculations of the PLFT method are proportional to the 3D-TRUS prostate shrinkage by a factor of 0.5 and have a precision of approximately ±10 cm 3 for 90% of the patients during the first year after treatment.
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long term followup of randomized transurethral Microwave Thermotherapy versus transurethral prostatic resection study
The Journal of Urology, 2001Co-Authors: D L Floratos, F M J Debruyne, Lambertus A Kiemeney, Cristina Rossi, Barbara B M Kortmann, Jean J.m.c.h. De La RosetteAbstract:Purpose: We evaluate the durable effect of high-energy transurethral Microwave Thermotherapy and transurethral prostatic resection for treatment of patients with lower urinary tract symptoms suggestive of bladder outflow obstruction.Materials and Methods: Between January 1996 and March 1997, 155 patients with lower urinary tract symptoms suggestive of bladder outflow obstruction were randomized to receive transurethral Microwave Thermotherapy (Prostatron * *EDAP Technomed, Lyon, France.; device and commercial software) (82) or undergo transurethral prostatic resection (73). Initial patient evaluation was performed according to international standards. Patients were followed annually with the International Prostate Symptom Score (I-PSS) and uroflowmetry (maximum flow rate). The Kaplan-Meier survival analysis was used to calculate the cumulative risk of re-treatment, adjusted for loss to followup.Results: A total of 78 patients received transurethral Microwave Thermotherapy and 66 underwent transurethral pr...