Transurethral hyperthermia for benign prostatic hypertrophy

Summary

A total of 62 patients with benign prostatic hypertrophy (BPH) were treated in one single session with a second-generation hyperthermic device using the transurethral approach. Before the treatment and at each month thereafter, we evaluated the volume of the prostate by transrectal ultrasound, the urinary flow, the amount of residual urine and the prostatic specific antigen (PSA) level. There was a 2-fold increase in PSA levels at 1 day after treatment, but the values returned to normal after 1 month. No change in prostatic volume was observed. Among a group of 17 patients showing retention, 8 who were discharged without a catheter at 1 week after treatment showed minimal residue and acceptable flow. In all, 39 patients were evaluable after a 2- to 4-month follow-up. At 2 months of follow-up, 77% of the evaluable patients showed subjective improvement and 45% exhibited objective signs of improvement. Obvious pathological modifications were observed in 7/8 patients who underwent an open retropubic prostatectomy after hyperthermia treatment. Histology revealed areas of focal glandular necrosis around the preserved urethra, suggesting a possible diminution of urethral resistance to bladder outflow. Minimal side effects were encountered that did not limit the treatment. A long-term follow-up period is mandatory for better definition of the indications and limits of this new technique.