Treatment of benign prostatic hypertrophy
by transurethral thermotherapy
The treatment of benign prostatic hypertrophy depends on objective (clinical parameters) and subjective (discomfort and effects on the quality of life) considerations, where patient's choice clearly remains a major decision-making factor.
For a high number of patients without severe complications, the first-line treatment for this condition is medical treatment: phytotherapy, alpha-blockers, 5-alpha-reductase inhibitors, and, more recently, the association of an alpha-blocker with a 5-alpha-reductase inhibitor (bitherapy). This is a symptomatic treatment that requires life-long medication intake. However, a number of patients are not relieved by these treatments (2/3 of patients declare that they experience some degree of discomfort regardless of the improvement of clinical parameters) and do not tolerate their side effects (particularly those affecting the cardio-vascular system) or have a disease progress. This ineffectiveness or the onset of complications (urine retention, bladder stones, kidney failure) usually lead to the proposition of a surgical treatment. At the present time, the most common procedures are open adenomectomy and, most of all, transurethral resection of the prostate (TURP). This procedure, which is practiced in 80% of cases, remains an invasive solution whose major side effects are bleeding and disorders of the sexual function (erectile dysfunctions and retrograde ejaculation). Other less invasive techniques have been developed in the course of the last decade: thermotherapy (microwave, Prostiva™...), laser therapies, transurethral vaporization... The Prostiva™ system permits a preservation of the sexual and reproductive function of patients and offers the opportunity to treat the patient with a reduced hospitalization rate, or even in an outpatient clinic. However, the most frequently observed side effect is a transient urinary retention which, in the majority of cases, requires postoperative catheterization for a few days.
Principle of thermotherapy: Use of the heat provided by microwave energy or by radiofrequency to necrotize the prostatic tissue responsible of the urinary obstruction.
This principle is not new, but its innovative nature lies in the increased power of the equipment, which now allows for higher intraprostatic temperatures (44- 45°C for hyperthermia; > 50°C for thermotherapy; 115°C for radiofrequency). These temperatures are obtained while preserving the urethra, rectum and the internal and external urinary sphincters thanks to a urethral cooling system and to alarm systems that automatically interrupt the heat emission when the rectal and/or urethral temperature exceeds a preset threshold.
The Prostiva™ system is used with a transurethral approach for the thermoablation treatment of benign prostatic hypertrophy. The device consists of two radiofrequency electrodes that deliver energy to cause a coagulative necrosis of the defined areas, essentially of smooth muscle cells, a phenomenon that triggers a permanent alpha-blocking effect.
The material includes a radiofrequency generator, a treatment handle with a telescope installed on it to allow for the direct visualization of the positioning of the disposable cartridge provided with treatment needles, and a disposable irrigation system to reduce tissue heating and rinse the urethra.
The specific feature of the Prostiva™ method is its capacity to perform a targeted treatment in the obstructed areas of the prostate. Its array of needles allows for the most effective application of heat to the tissue. The system also allows for the preservation of certain areas, such as the bladder neck, thus facilitating antegrade ejaculation and avoiding erectile problems.
This is the latest first-line treatment of benign prostatic hypertrophy used in the United States , whose results in Europe are extremely promising.
PROSTIVA™ RF Therapy
>>> Treatment of Benign Prostatic Hyperplasia [PDF]