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High-energy feedback microwave thermotherapy and intraprostatic injections of mepivacaine and adrenaline: an evaluation of calculated cell kill accuracy and responder rate.

Artikel i vetenskaplig tidskrift
Författare Fredrik Stenmark
Lars Brudin
Johan Stranne
Ralph Peeker
Publicerad i Scandinavian journal of urology
Volym 48
Nummer/häfte 4
Sidor 374-378
ISSN 2168-1813
Publiceringsår 2014
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för urologi
Sidor 374-378
Språk en
Länkar dx.doi.org/10.3109/21681805.2013.87...
Ämnesord Adrenaline, benign prostatic hyperplasia, intraprostatic injection, mepivacaine, microwave thermotherapy
Ämneskategorier Urologi och andrologi

Sammanfattning

Abstract Objective. The aim of this study was to evaluate cell kill accuracy and responder rate when using injections of intraprostatic mepivacaine and adrenaline (MA) before high-energy microwave thermotherapy (HE-TUMT). Material and methods. This retrospective evaluation encompassed 283 treatments in men with lower urinary tract symptoms or urinary retention due to benign prostatic hyperplasia. They were treated consecutively during 2003-2008 using HE-TUMT with a feedback technique. Immediately before treatment, MA was administered into the prostate via a Schelin Catheter®. Clinical outcome was evaluated 3 months after treatment using a validated symptom score, transrectal ultrasound, peak urinary flow and postvoid residual. Results. Systematic underestimation of the resulting coagulation necrosis was a consistent finding when using MA, a calculated cell kill of 21% yielding a volume reduction of 26% for prostate volumes less than 100 ml and 31% for prostate volumes greater than or equal to 100 ml. Mean prostate volume was 74 ml and mean treatment time was 13 min. Less than 1% of the patients needed analgesics or sedatives on demand. Analysis of the data showed an estimated clinical responder rate of approximately 87%. Conclusions. The resulting prostate volume reduction corresponds to the earlier empirically recommended 30% cell kill for CoreTherm® without MA. The treatment concept combining CoreTherm with intraprostatic injections of MA corresponds to the clinical outcome of thermotherapy without MA, with the benefits of reduced pain, shortened treatment time and decreased energy consumption.

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