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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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Long-term followup of randomized Transurethral Microwave Thermotherapy versus Transurethral prostatic resection study.
'Elsevier BV', 2001Co-Authors: Floratus D., Rossi C., Kiemeney L.a.l.m., Kortmann B.b.m., Debruyne F.m.j., J.j.m.c.h. De La RosetteAbstract:Item does not contain fulltextPURPOSE: 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*; 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 prostatic resection. Median followup was 33 months. In the Thermotherapy group mean maximum urinary flow rate improved from 9.2 ml. per second at baseline to 15.1, 14.5 and 11.9 ml. per second at 1, 2 and 3 years, and mean I-PSS decreased from 20 to 8, 9, and 12, respectively. In the resection group the corresponding numbers for maximum urinary flow rate were 7.8, 24.5, 23.0 and 24.7 ml. per second at 1, 2 and 3 years, and for I-PSS were 20, 3, 4 and 3, respectively. At 36 months, 14 patients in the Thermotherapy and 8 from the resection groups underwent re-treatment, and the cumulative risk was 19.8% (95% confidence interval 10.4% to 29.3%) and 12.9% (4.5% to 21.3%), respectively (p = 0.28). CONCLUSIONS: Transurethral Microwave Thermotherapy and Transurethral prostatic resection achieve durable improvement in patients with lower urinary tract symptoms suggestive of bladder outflow obstruction, while the magnitude of improvement is higher with resection. The repeat Thermotherapy is based on failure of therapy whereas repeat resection is based on complications of therapy
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Long-term followup of randomized Transurethral Microwave Thermotherapy versus Transurethral prostatic resection study.
'Elsevier BV', 2001Co-Authors: Floratus D., Rossi C., Kiemeney L.a.l.m., Kortmann B.b.m., Debruyne F.m.j., J.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*; 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 prostatic resection. Median followup was 33 months. In the Thermotherapy group mean maximum urinary flow rate improved from 9.2 ml. per second at baseline to 15.1, 14.5 and 11.9 ml. per second at 1, 2 and 3 years, and mean I-PSS decreased from 20 to 8, 9, and 12, respectively. In the resection group the corresponding numbers for maximum urinary flow rate were 7.8, 24.5, 23.0 and 24.7 ml. per second at 1, 2 and 3 years, and for I-PSS were 20, 3, 4 and 3, respectively. At 36 months, 14 patients in the Thermotherapy and 8 from the resection groups underwent re-treatment, and the cumulative risk was 19.8% (95% confidence interval 10.4% to 29.3%) and 12.9% (4.5% to 21.3%), respectively (p = 0.28). CONCLUSIONS: Transurethral Microwave Thermotherapy and Transurethral prostatic resection achieve durable improvement in patients with lower urinary tract symptoms suggestive of bladder outflow obstruction, while the magnitude of improvement is higher with resection. The repeat Thermotherapy is based on failure of therapy whereas repeat resection is based on complications of therapy
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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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sexual function following high energy Microwave Thermotherapy results of a randomized controlled study comparing Transurethral Microwave Thermotherapy to Transurethral prostatic resection
The Journal of Urology, 1999Co-Authors: E A E Francisca, F C H Dancona, E J H Meuleman, F M J Debruyne, J.j.m.c.h. De La RosetteAbstract:AbstractPurpose: We evaluate changes in sexual function in patients treated with high energy Transurethral Microwave Thermotherapy compared to Transurethral resection of the prostate.Materials and Methods: A total of 147 patients randomized to undergo Transurethral Microwave Thermotherapy or Transurethral resection of the prostate were asked to complete a self-administered questionnaire evaluating sexual function before, and 3 and 12 months after treatment. The questionnaire dealt with such items as social status, libido, quality of erection, ejaculation and overall satisfaction of sexual functioning.Results: There was a statistically significant improvement of micturition in both groups. The improvement in the Transurethral prostatic resection group was significantly better than in the Transurethral Microwave Thermotherapy group. Antegrade ejaculation occurred at 3 months following treatment in 27% of the Transurethral prostatic resection group compared to 74% of the Transurethral Microwave Thermotherapy...
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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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.
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sexual function following high energy Microwave Thermotherapy results of a randomized controlled study comparing Transurethral Microwave Thermotherapy to Transurethral prostatic resection
The Journal of Urology, 1999Co-Authors: E A E Francisca, F C H Dancona, E J H Meuleman, F M J Debruyne, J.j.m.c.h. De La RosetteAbstract:AbstractPurpose: We evaluate changes in sexual function in patients treated with high energy Transurethral Microwave Thermotherapy compared to Transurethral resection of the prostate.Materials and Methods: A total of 147 patients randomized to undergo Transurethral Microwave Thermotherapy or Transurethral resection of the prostate were asked to complete a self-administered questionnaire evaluating sexual function before, and 3 and 12 months after treatment. The questionnaire dealt with such items as social status, libido, quality of erection, ejaculation and overall satisfaction of sexual functioning.Results: There was a statistically significant improvement of micturition in both groups. The improvement in the Transurethral prostatic resection group was significantly better than in the Transurethral Microwave Thermotherapy group. Antegrade ejaculation occurred at 3 months following treatment in 27% of the Transurethral prostatic resection group compared to 74% of the Transurethral Microwave Thermotherapy...
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...
De La Rosette, J. J. - One of the best experts on this subject based on the ideXlab platform.
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Intra-prostatic vasculature studies: can they predict the outcome of Transurethral Microwave Thermotherapy for the management of bladder outflow obstruction?
2001Co-Authors: Floratos D. L., Debruyne F. M., Wijkstra H., Kortmann B. B., Sedelaar J. P., Aarnink R. G., De La Rosette, J. J.Abstract:BACKGROUND: Blood perfusion regulates intraprostatic temperatures during Transurethral Microwave Thermotherapy (TUMT). We evaluated baseline intraprostatic vasculature, as a predictor of efficacy of TUMT. METHODS: Twenty-two patients, with lower urinary tract symptoms (LUTS) suggestive of bladder outflow obstruction, were treated with TUMT (Prostatron). At baseline, three-dimensional contrast-enhanced power-flow-Doppler prostate ultrasonography (3D-CE-PFD) was performed. Assuming that the percentage of perfused area (PPA) is a realistic measure of blood flow, it was used to quantify intraprostatic vasculature. RESULTS: The median (range) age, prostate size, and energy delivered were 66 years (48-80), 47 cm(3) (30-121), 110 kJ (29-136), respectively. The response was 77% (5 failures). The median (range) PPA was 2.76% (0.7-11.3). No difference in PPA among good and poor responders was detected nor was any correlation between PPA and baseline parameters. CONCLUSIONS: The baseline intraprostatic vascularization, documented by CE-PFD studies, has no predictive value for the efficacy of TUMT. It seems that "static" baseline blood flow does not reflect the "dynamic" thermoregulatory role of blood flow during treatmen
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Long-term followup of randomized Transurethral Microwave Thermotherapy versus Transurethral prostatic resection study
2001Co-Authors: Floratos D. L., Kiemeney L. A., Debruyne F. M., Rossi C., Kortmann B. B., De La Rosette, J. J.Abstract: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. 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*; 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. A total of 78 patients received Transurethral Microwave Thermotherapy and 66 underwent Transurethral prostatic resection. Median followup was 33 months. In the Thermotherapy group mean maximum urinary flow rate improved from 9.2 ml. per second at baseline to 15.1, 14.5 and 11.9 ml. per second at 1, 2 and 3 years, and mean I-PSS decreased from 20 to 8, 9, and 12, respectively. In the resection group the corresponding numbers for maximum urinary flow rate were 7.8, 24.5, 23.0 and 24.7 ml. per second at 1, 2 and 3 years, and for I-PSS were 20, 3, 4 and 3, respectively. At 36 months, 14 patients in the Thermotherapy and 8 from the resection groups underwent re-treatment, and the cumulative risk was 19.8% (95% confidence interval 10.4% to 29.3%) and 12.9% (4.5% to 21.3%), respectively (p = 0.28). Transurethral Microwave Thermotherapy and Transurethral prostatic resection achieve durable improvement in patients with lower urinary tract symptoms suggestive of bladder outflow obstruction, while the magnitude of improvement is higher with resection. The repeat Thermotherapy is based on failure of therapy whereas repeat resection is based on complications of therap
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Transurethral Microwave Thermotherapy in the armamentarium of therapeutic modalities for benign prostatic hyperplasia
2000Co-Authors: Floratos D. L., Debruyne F. M., Alivizatos G. J., De La Rosette, J. J.Abstract:Transurethral Microwave Thermotherapy (TUMT) has gained a firm place in the spectrum of therapeutic modalities for management of patients with lower urinary tract symptoms suggestive of bladder outflow obstruction. To achieve optimum results following TUMT, intense research focuses on appropriate patient selection, heat-tissue interactions, and modification of technical specifications. Results of TUMT are good to excellent for the majority of patients, but there is a non-negligible number of patients who respond poorly. The selection of favorable candidates for TUMT aims to improve the therapeutic results, and both clinical baseline parameters and intrinsic characteristics of the prostate (histologic composition and vasculature) may influence treatment outcome. TUMT achieves therapeutic response through coagulative necrosis of the hyperplastic tissue, but additional theories have been proposed recently, suggesting that TUMT may cause neural destruction and induce apoptosis. Individualization of the treatment is expected to offer the best results, and because the temperature achieved inside the prostate determines the actual parenchymal necrosis, thermal monitoring during treatment will permit application of Microwave energy in a feedback mode. Various Microwave devices differ in technical specifications (operating frequency, design of antenna, cooling system), and recently introduced software programs (high-energy protocols, heat-shock strategy, short-duration protocols) aim at better efficacy, providing a more patient-friendly procedure. TUMT has survived the "test of time" that other, initially promising, modalities have failed. What remains to be determined is the maximum benefit that patients and health systems can gain from such a techniqu
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Intraprostatic temperature monitoring during Transurethral Microwave Thermotherapy: status and future developments
'Mary Ann Liebert Inc', 2000Co-Authors: Hoffmann A. L., De La Rosette, J. J., Wijkstra H.Abstract:Transurethral Microwave Thermotherapy is being applied as a minimally invasive treatment for alleviating the symptoms of urinary outlet obstruction associated with benign prostatic hyperplasia. Treatment progress has traditionally been guided in its effective power by rectally and urethrally measured temperatures, whereas intraprostatic temperatures would be preferred for feedback purposes. A critical evaluation is presented of intraprostatic thermometry techniques that have been suggested, the techniques currently being used and investigated, and the problems that remain to be solved. Techniques for noninvasive temperature measurement and detecting tissue response during thermal therapy are discussed in more detail. Results presented in the literature have shown magnetic resonance imaging and ultrasonic imaging to be adequate thermometry modalities. For treatment monitoring of Transurethral Microwave Thermotherapy, ultrasonic imaging is especially promising. Future research will indicate whether the promise evolves into a sound clinical techniqu
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Efficacy and safety of the new high-energy 30-minute Transurethral Microwave Thermotherapy: results of 1-year follow-up in a multicenter study
2000Co-Authors: De La Rosette, J. J., Debruyne F. M., Kortmann B. B., Laguna M. P., Pace G., Selvaggio O., Selvaggi F. P.Abstract:To assess the efficacy and durability of a new 30-minute 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. A total of 167 men (mean age 67 years) with bothersome LUTS were treated with the new TUMT protocol. Evaluation included assessment of the short- and long-term objective and subjective outcome measures of this treatment. The treatment is well tolerated. The International Prostate Symptom Score improved from a mean of 19.2 at baseline to 7.9 at 12 months after treatment. Maximum urinary flow improved from 8.9 to 16.4 mL/s at 12 months. Mean duration of catheterization was 16.1 days. Urodynamic evaluation showed a change from the obstructed to the nonminimally obstructed zone. There were no serious complications. High-energy TUMT using the new high-dose Prostasoft 3.5 protocol appears to be a safe, effective, and durable treatment. The faster procedure improves tolerance of the treatment. Subjective and objective improvements were significant and the treatment-related morbidity lo
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...
