TURAPY - TransURethral Ablation Prostatectomy by high temperature radiofrequency - Preliminary results of a multicenter study

Abstract

Thermal treatment of BPH has been introduced several years ago as an alternative treatment modality for patients suffering from symptomatic BPH. The initial temperatures ranged from 44.5 to 48°C. With these temperatures, about 60~70% of the patients showed significant improvement of their subjective, mainly irritative symptoms with only mild changes in their obstructive parameters. In order to improve the therapeutic effects, increase in energy delivered allowing higher temperatures in the order to 70~100°C was investigated regarding the feasibility, tolerance, pathological lesions and clinical effectiveness. A new, radiofrequency technique, TURAPY-TransURethral Albation Prostatectomy, an outpatient ablative BPH treatment has been introduced recently. The treatment is applied transurethrally with a helicoidal antenna without any cooling system. Temperature delivery in the order of medium 75°C was applied during a medium time of 45 minutes. An ongoing multicenter study included 38 patients. 15 patients were operated by retropubic prostatectomy after 6~30 days, for a histopathology study and 23 eligible patients were entered in a clinical study and analyzed to determine the efficacy of the TURAPY treatment. The tolerance was excellent and although patients experienced initial heating sensation at the onset of treatment, as the temperature rose to 40~50°C (as with previous modalities of thermotherapy), they did not experience further pain and the procedure was never stopped. Urinary retention was observed in about 80% of the patients, due to the extensive tissular destruction. These patients had suprapubic catheter inserted one day to a maximum of one week (medium 3 days). Pathological findings of the operated specimens showed extensive coagulative necrosis of all tissular components of the prostatic tissue (glandular elements, fibromuscular stroma), extending up to 40 mm from the urethra. Magnetic resonance imaging (MRI) was performed before and after TURAPY. Absence of captation of Gadolinium in T2 sequences was seen in areas of the prostate corresponding to the necrosis seen in the pathological specimens. Cystourethroscopy showed the prostatic urethra filled with necrotic tissue, with constant sluffing of the dead tissue and cavity formation at 8 weeks. The symptom score improved from 22 to 7 (mean values) at the 3 month follow up. Peak flow rate increased on average from 5.3 ml/sec to 9.7 ml/sec at 1 month and to 13.3 ml/sec at 3 months. Postvoiding residual volume decreased from a mean value of 181 ml, with 3 patients in retention to 78 ml (1 month) and improved further to 52 ml, with 1 patient in retention (3 months). The peak flow rate significantly improved (defined as a change of 50% or more) in 82% of the patients at the 1 month follow up. The histopathology and clinical results establish Turapy as a safe and effective treatment of BPH, in relieving patients of irritative symptoms as well as obstructive symptoms, in a single, anesthesia free, 1 hour outpatient session.