Transurethral balloon laser hyperthermia for chronic non-bacterial prostatitis: a clinical trial

Therapeutic effect of transurethral needle ablation in non-bacterial prostatitis: chronic pelvic pain syndrome type IIIa

AIM

Non-bacterial prostatitis is difficult to manage with conventional treatment. This study was undertaken to evaluate the therapeutic effect of transurethral needle ablation (TUNA) on men with chronic inflammatory non-bacterial prostatitis.

METHODS

Thirty-two patients with non-bacterial prostatitis (type IIIa) were treated with TUNA. The TUNA procedure, which uses radiofrequency energy, heats the prostate tissue to approximately 90-110 degrees C over a 5-min period. Evaluation consisted of a prostatitis symptom severity score chart, the monitoring of the leukocyte count in the expressed prostatic secretion (EPS) and a subjective global assessment.

RESULTS

The decrease in the prostate symptom severity score chart at 3 and 6 months compared with the baseline assessment was statistically significant. Analysis of the leukocyte levels in the EPS in 14 patients was available. All 14 patients had a decrease in the EPS leukocyte count 3 months after treatment. However, six of these men (43%) still had EPS leukocyte levels above the normal indices (>10 white blood cells per high-power field). A second session of TUNA on these partial responders resulted in three of the six men obtaining a normal EPS leukocyte count. At 6 months following treatment, complete, partial and poor improvement in terms of subjective global assessment were noted in 60, 35 and 5% of patients, respectively. No major complications, including those of sexual dysfunction or retrograde ejaculation, were noted in this cohort.

CONCLUSIONS

Transurethral needle ablation appears to be an easy, safe and effective treatment for men with chronic inflammatory non-bacterial prostatitis.

Transurethral needle ablation for chronic nonbacterial prostatitis

OBJECTIVE

To investigate the efficacy of transurethral needle ablation (TUNA) of the prostate for treating chronic nonbacterial prostatitis unresponsive to conservative therapies.

PATIENTS AND METHODS

Forty-two patients (mean age 38.5 years, range 25-52) with nonbacterial prostatitis in whom clinical management was unsuccessful in relieving the symptoms or signs of prostatitis were treated using TUNA. All patients had a high leukocyte count (> 15 per high-power field) in expressed prostatic secretions (EPS) with no bacterial growth in either urine or prostatic secretion cultures. Before TUNA all patients were evaluated using a symptom score, satisfaction score (quality of life) and an examination of prostatic secretions. All patients were reassessed using the same variables 1 and 3 months after TUNA. Of the 42 patients, 10 had their semen analysed before and 3 months after treatment.

RESULTS

The mean (sd) symptom and satisfaction scores improved significantly, from 11.02 (2.90) to 5.00 (2.61) and from 4.84 (0.57) to 1.26 (1.18), respectively, 3 months after TUNA (both P < 0.05). Of the 42 patients, 30 (71%) had normal EPS results within 3 months of TUNA. Also, of 37 patients with high leukocyte counts (> 100 per high-power field) before TUNA, 26 (70%) had normal EPS results within 3 months afterward, and 29 (78%) had a satisfaction score of < 3 points.

CONCLUSIONS

TUNA may be a possible treatment option for patients with chronic nonbacterial prostatitis that is unresponsive to conservative therapies. A long-term follow-up and randomized studies are needed to confirm the efficacy of the TUNA against intractable chronic prostatitis.

Transurethral balloon laser enhanced thermotherapy in the canine prostate

BACKGROUND AND OBJECTIVE

Hyperthermia is performed for prostate cancer. We examined the selective induction of coagulonecrotic changes in the objective area of the canine prostate in enhancing the effect of hyperthermia and treating the target area with transurethral balloon laser enhanced thermotherapy (TUBAL-ET) using a light absorbent material.

STUDY DESIGN/MATERIALS AND METHODS

The heat exchange of ultrafine carbon particles after laser irradiation was observed in a phantom study using thermography. The carbon solution was injected at the right prostatic lobe in dogs and TUBAL-ET was performed.

RESULTS

The charcoal absorbed the Nd:YAG laser energy and apparently converted it into thermal energy in the phantom study by thermographic observation. TUBAL-ET induced coagulonecrotic changes only at the area at which carbon had been injected in the prostate gland. The necrotic tissue was almost absorbed at four weeks after treatment.

CONCLUSIONS

TUBAL-ET induces tissue damage at the target area in the prostate gland.

Pilot study of transurethral needle ablation (TUNA) in treatment of nonbacterial prostatitis

Transurethral needle ablation (TUNA) was performed on seven patients with chronic nonbacterial prostatitis who failed to respond to conventional treatments administered for more than half a year. The TUNA procedure heated the prostate to a temperature ranging from 90 degrees to 100 degrees C while the urethral temperature was maintained below 43 degrees C by a protective sheath and irrigation. After treatment, four patients showed complete resolution of symptoms and three a partial improvement. All patients had a decrease in the leukocyte count in expressed prostatic secretions (EPS) 1 month after treatment. Recurrence of abnormal inflammatory cells in the EPS was noted in two patients at 3 months after treatment. The subjective improvement has been maintained during the subsequent follow-up. From these results, TUNA is considered to be an effective, safe, and easy treatment for most patients with nonbacterial prostatitis.

Treatment with neodymium: YAG laser in patients with chronic prostatitis: a preliminary report

A group of 30 patients with chronic abacterial prostatitis or prostatodynia, all of whom were unresponsive to conventional treatments, underwent transurethral neodymium: YAG laser therapy. The patients were evaluated with both objective and subjective parameters before and after treatment. Following treatment, the preliminary results at six months showed positive response (complete plus partial) rates in subjective parameters ranging from 47% to 86%. On the other hand, objective parameters including mean international prostate symptom scores (IPSS), mean quality of life indexes (QoL), mean uroflowmetric measurements and mean leukocyte count in expressed prostatic secretions showed marked improvements which were meaningful statistically. In 4 of 7 patients who underwent needle biopsy of the prostate, histology revealed definite inflammatory infiltration changes. Control biopsies following treatment showed almost complete disappearance of these changes. These preliminary results open up a new treatment modality in the management of this condition which has so far responded poorly to conventional therapy.