transrectal high intense bph
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Transrectal High-Intensity Focused Ultrasound Safe, Effective for
BPHhttp://www.medscape.com/viewarticle/453231?src=search
Emma Hitt, PhD
April 29, 2003 (Chicago) Transrectal high-intensity focused ultrasound (HIFU) therapy appears to be safeand effective for treating benign prostatic hyperplasia (BPH), according to a new study presented here at theannual meeting of the American Urological Association.
Allen D. Seftel, MD, from the Department of Urology at Case Western Reserve University in Cleveland, Ohio,and colleagues conducted a phase III study of 68 BPH patients aged 50 to 80 years at five centers. Theyevaluated the Sonablate HIFU device.
Normal rectal wall temperature was maintained throughout the 38-minute procedure via an additional rectalcooling balloon within the HIFU probe. To enhance the effect of ultrasound beam on the targeted tissue, aurethral Foley catheter was inserted into the bladder to aid in positioning and was kept in-situ during thetreatment. Procedures were performed under either general anesthesia or intravenous sedation, neither of
which had an obvious effect on outcome.
Patients returned home within a few hours after the procedure and the catheter was removed after four tofive days.
One year after treatment, a 34% improvement in Qmax score (8.7 mL/sec to 11.7 mL/sec) and a 63%improvement in AUA Symptom Score (23.06 to 10.83) were observed. Furthermore, cystoscopic examinationrevealed significant prostate tissue changes after treatment, with 80% of patients showing cavity formation atthe treatment site in the bladder neck and prostate.
All of the patients were treated safely without significant pain, blood loss, or complications, Dr. Seftel andcolleagues report. Minor complications included hematospermia in 28% of patients and hematuria in 23% ofpatients. Transient retention, transient incontinence, and urinary tract infection were also observed in 10% orfewer patients. Long-term dysuria and impotence were not observed.
"We believe this therapy may be comparable to the gold standard transurethral resection of the prostate[TURP]," said Dr. Seftel.
According to Dr. Seftel, the results are also quite durable. "The procedure has now been demonstrated toremain effective for about five years," he told Medscape. "Anecdotally, we've noted some improvement inerectile function, and there's been no evidence of incontinence or rectal injuries," he added.
Dr. Seftel noted that patients may be more likely to have irritative symptoms with HIFU compared with TURP,as well as more frequency and perhaps some blood in the urine for a few days. "But the side effects arelimited and overall the results compare favorably," he said.
Claus Roehrborn, MD, professor and chairman of the Department of Urology at the University of TexasSouthwestern Medical Center in Dallas, noted that minimally invasive methods such as this one showpromise, but the gold standard TURP is known to improve symptoms in 95% or more of patients.
"This study does not compare individual patients with themselves at baseline," he continued. "Rather itevaluates the average of the symptom scores, and this may mean that 20% to 30% of patients don't improveupon their own symptom scores a much lower success rate than that of TURP."
The study was funded by Focus Surgery, Inc., Indianapolis, Indiana, the manufacturers of the HIFU device.
AUA 98th Annual Meeting: Abstract 1453. Presented April 29, 2003.
Reviewed by Gary D. Vogin, MD
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Emma Hitt, PhD Independent medical writer, Marietta, Georgia
Medscape Medical News is edited by Deborah Flapan, assistant managing editor of news at Medscape.Send press releases and comments to [email protected].
Medscape Medical News 2003. 2003 Medscape
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