Transurethral microwave thermotherapy and transurethral resection of the prostate. Evaluation and development

Sammanfattning: ABSTRACT Lower urinary tract symptoms (LUTS) are common among men and become more prevalent with increasing age. One frequent cause is benign prostatic obstruction (BPO). Patients with LUTS/BPO can be ameliorated if the obstructive tissue is removed. The reference surgical method is transurethral resection of the prostate (TURP), and an outpatient alternative is transurethral microwave thermotherapy (TUMT). In Paper I, we evaluated the accuracy of the calculated cell kill (CK) using advanced TUMT, the CoreTherm Concept (CoreTherm™, ProstaLund AB, Lund, Sweden). A total of 278 treatments were retrospectively analysed. It was apparent that CK calculated by the software during treatment underestimated the actual prostate volume reduction. For prostate volumes <100 ml before treatment the prostate volume reduction measured by transrectal ultrasound (TRUS) was 26% (p=0.003), and for prostate volumes ≥100 ml the prostate volume reduction measured by TRUS was 31% (p<0.001). Paper II was a study with the primary objective of evaluating pretreatment parameters in order to estimate an appropriate thermal dose for each case. It was evident that energy delivery was correlated to prostate volume (p<0.001), the larger the prostate, the more energy was needed to achieve the desired volume reduction. The study also showed that age correlated to energy consumption (p=0.01), where older men required less energy, despite having the same prostate size. Consequently, it is possible to calculate the thermal dose before treatment and use this as an alternative treatment endpoint. In Paper III, the short- and long-term efficacy of the CoreTherm Concept and CoreTherm in prostates ≥ 80 ml were evaluated in 570 patients. Patients treated 1999-2015 were included and followed up until the end of 2019. A total of 17 patients (3.0%) were retreated with open surgery and 54 patients (9.5%) with TURP. The conclusion was that the CoreTherm Concept is a valuable outpatient option to surgery for patients with large prostates. Paper IV was an open, prospective, controlled, randomised multicenter study of TURP after intraprostatic injections of mepivacaine and adrenaline (MA) versus regular TURP in patients with LUTS/BPO. The primary objective of this study was to determine whether injections of MA, administered via the Schelin catheter (Schelin Catheter™, ProstaLund AB, Lund, Sweden) before and during TURP, reduced perioperative bleeding. The results indicate that it might be beneficial to apply intraprostatic injections of MA in conjunction with TURP, although further studies are deemed necessary.