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

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.

Key Words::

• Adrenaline
• benign prostatic hyperplasia
• intraprostatic injection
• mepivacaine
• microwave thermotherapy

Acknowledgement

This work was supported by Sahlgrenska University Hospital project number ALF 7582.

Declaration of interest : The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.