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Development of Feedback Microwave Thermotherapy in Symptomatic Benign Prostatic Hyperplasia.

Schelin, Sonny LU (2006) In Lund University Faculty of Medicine Doctoral Dissertation Series 2006:25.
Abstract
Abstract: The purpose of this thesis was to evaluate ProstaLund Feedback Treatment® (PLFT®) and the CoreTherm® device with regard to biophysics, mechanisms of action, treatment indications, additional techniques, efficacy and safety in the treatment of patients with benign prostatic hyperplasia (BPH). The application of two biophysical equations in the PLFT software is explained. The calculations provide the intraprostatic ?blood flow index? and amount of accumulated coagulation necrosis during treatment. The accuracy of the ?cell kill? calculations is compared to gadolinium-enhanced magnetic resonance imaging (MRI) and histology. The accumulated ?cell kill? monitored on-line during PLFT is considered a useful tool for helping the doctor... (More)
Abstract: The purpose of this thesis was to evaluate ProstaLund Feedback Treatment® (PLFT®) and the CoreTherm® device with regard to biophysics, mechanisms of action, treatment indications, additional techniques, efficacy and safety in the treatment of patients with benign prostatic hyperplasia (BPH). The application of two biophysical equations in the PLFT software is explained. The calculations provide the intraprostatic ?blood flow index? and amount of accumulated coagulation necrosis during treatment. The accuracy of the ?cell kill? calculations is compared to gadolinium-enhanced magnetic resonance imaging (MRI) and histology. The accumulated ?cell kill? monitored on-line during PLFT is considered a useful tool for helping the doctor to tailor the individual ?thermal dose? to each patient. The clinical efficacy, 1 and 5 years after PLFT and Trans-urethral Resection of the Prostate (TURP), is compared showing no statistically significant differences. Serious adverse events were more frequent after TURP. Expanded treatment indications for PLFT, to including patients with persistent urinary retention and patients with heavily enlarged prostates (>100 g), were studied in a retrospective survey and in a prospective randomized multicentre study comparing PLFT with surgery (TURP and open surgery). Responder rate after PLFT was close to 80% and statistically equivalent to surgery after 6 months. Serious adverse events were less frequent after PLFT. The intraprostatic blood flow works like a heat sink by transporting heat away from the treatment area during thermotherapy. This is the explanation for the unpredictable outcome and frequent treatment failures described after low-energy transurethral microwave thermotherapy. High-energy TUMT can compensate for this in many ways but results in significant patient discomfort from micturition urge, burning sensations and pain.



A new device, the Schelin Catheter®, makes it possible to inject and infiltrate the prostate by the transurethral route. Injections in several locations with local anaesthetics containing epinephrine have a twofold aim: 1) to minimize the intraprostatic blood flow and 2) to achieve good analgesia. Treatment time was reduced by 50% and the total energy required was reduced by 60% when using this technique. The effects of the epinephrine on the intraprostatic blood flow were also verified with positron emission tomography, [15O]H2O-PET.



The results in this thesis show that the efficacy, safety and methodological improvements of PLFT now make it a challenger to surgery (TURP and open surgery) as a convenient, office based and more available option. This truly minimally invasive treatment is an attractive option for patients that can replace surgery for the majority of patients with clinical BPH. It also reduces the cost to the taxpayer. (Less)
Abstract (Swedish)
Popular Abstract in Swedish

Abstract: Denna avhandling utvärderar CoreTherm systemet och dess metod för mikrovågsbehandling (TUMT), ProstaLund Feedback Treatment (PLFT), vid symtomgivande ålderförstorad prostata (BPH). Avhandlingen belyser biofysik, verkningsmekanismer, behandlingsindikationer, tilläggsmetoder, effektivitet och säkerhet vid PLFT. Två biofysiska ekvationer kan appliceras i en beräknings-modell. Systemets mjukvara kan med hjälp av dessa fortlöpande beräkna ett ?blodflödesindex? och den uppnådda vävnadsskadan under pågående behandling. Noggrannheten i dessa beräkningar undersöks genom jämförelse med gadolinium-förstärkt magnetröntgen och histologisk undersökning av prostatapreparat. PLFT systemets beräkning av... (More)
Popular Abstract in Swedish

Abstract: Denna avhandling utvärderar CoreTherm systemet och dess metod för mikrovågsbehandling (TUMT), ProstaLund Feedback Treatment (PLFT), vid symtomgivande ålderförstorad prostata (BPH). Avhandlingen belyser biofysik, verkningsmekanismer, behandlingsindikationer, tilläggsmetoder, effektivitet och säkerhet vid PLFT. Två biofysiska ekvationer kan appliceras i en beräknings-modell. Systemets mjukvara kan med hjälp av dessa fortlöpande beräkna ett ?blodflödesindex? och den uppnådda vävnadsskadan under pågående behandling. Noggrannheten i dessa beräkningar undersöks genom jämförelse med gadolinium-förstärkt magnetröntgen och histologisk undersökning av prostatapreparat. PLFT systemets beräkning av den ackumulerade vävnadsdöden under behandling bedöms vara ett värdefullt hjälpmedel att avpassa rätt mängd värmeenergi till varje patient. Vid jämförelse med operationsbehandling med Transuretral Resektion av Prostata (TURP) i en multicenterstudie är behandlingseffekten likvärdig efter 1 och 5 år, utan några statistiskt signifikanta skillnader. Allvarliga komplikationer var vanligare efter TURP. Behandlingseffekten vid utvidgade behandlingsindikationer för PLFT, till att omfatta även patienter i kronisk urinretention och patienter med mycket kraftig förstoring (>100g), studerades. En retrospektiv genomgång av ett kliniskt patientmaterial och en jämförande, prospektiv, randomiserad multicenterstudie mot operationsbehandling (TURP/öppen operation) genomfördes. Cirka 80 % av patienterna kunde kateterbefrias efter PLFT och behandlingsresultatet var statistiskt likvärdigt med operationsbehandling. Allvarliga komplikationer inträffade mindre ofta efter PLFT. Blodflödet i prostata transporterar bort värme från behandlingsområdet under mikrovågsbehandling och motverkar och fördröjer den värmeökning som eftersträvas. Detta förklarar svårigheten att definiera kliniska prognostiska faktorer samt ett relativt stort antal misslyckade behandlingar med konventionell TUMT. Genom ökad energitillförsel under behandling förbättras resultaten men till priset av ökade obehag med kraftiga urinträngningar, brännande känsla och smärta under behandlingen.



Med hjälp av en ny teknik ? Schelinkatetern® - kan prostata injiceras och infiltreras med läkemedel genom en specialkonstruerad urinvägskateter. Genom injektioner med lokalbedövningsmedel som innehåller adrenalin uppnås två syften: 1) kraftigt minskat blodflöde i prostata och 2) en effektiv lokalbedövning. Behandlingstiden halveras och behandlingsenergin minskar med ca 60 % med hjälp av denna teknik. Adrenalineffekten på blodflödet i prostata bekräftas i en studie genom PET-scan, [15O]H2O-PET.



Resultaten i denna avhandling visar att PLFT nu utmanar TURP och öppen operation vad gäller effektivitet. Avseende tillgänglighet, patientvänlighet, säkerhet och kostnader tycks PLFT överträffa operationsbehandling och därmed vara mer tilltalande för både patienter och samhälle. PLFT gör nu anspråk på att vara den nya ?golden standard? och kan ersätta flertalet operationer, inkluderat både TURP och öppen operation, för symptomgivande BPH. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Dr Med Thorup Andersen, Jens, Roskilde University Hospital, Denmark
organization
publishing date
type
Thesis
publication status
published
subject
keywords
nephrology, Urologi, nefrologi, Urology, PET, Schelin Catheter, epinephrine, local anaesthetics, microwave thermotherapy, intraprostatic blood flow, PLFT, Benign Prostatic Hyperplasia, intraprostatic temperature, CoreTherm
in
Lund University Faculty of Medicine Doctoral Dissertation Series
volume
2006:25
pages
154 pages
publisher
Department of Urology, Clinical Sciences, Lund University
defense location
Great hall Centralblocket Lund University Hospital
defense date
2006-03-10 13:00:00
ISSN
1652-8220
ISBN
91-628-6717-2
language
English
LU publication?
yes
additional info
Magnus Bolmsjö, Sonny Schelin, Lennart Wagrell, Thayne Larson, Jean de la Rosette and Anders Mattiasson. 2000. Cell-kill modeling of microwave thermotherapy for treatment of benign prostatic hyperplasia. Journal of Endourology, vol 14 pp 627-635. Mary Ann Liebert, Inc publishers
Christian Huidobro, Magnus Bolmsjö, Thayne Larson, Jean de la Rosette, Lennart Wagrell, Sonny Schelin, Tomasz Gorecki and Anders Mattiasson. 2004. Evaluation of microwave thermotherapy with histopathology, magnetic resonance imaging and temperature mapping. The Journal of Urology, vol 171 pp 672-678. Lippincott Williams & Wilkins
Lennart Wagrell, Sonny Schelin, Jörgen Nordling, Jonas Richthoff, Bo Magnusson, Moddy Schain, Thayne Larson, Emmett Boyle, Jens Duelund, Kurt Kroyer, Håkan Ageheim and Anders Mattiasson. 2002. Feedback microwave thermotherapy versus TURP for clinical BPH - A randomized controlled multicenter study. Urology, vol 60 pp 292-299. Elsevier Inc.
Sonny Schelin. 2001. Microwave thermotherapy in patients with benign prostatic hyperplasia and chronic urinary retention. European Urology, vol 39 pp 400-404. S. Karger AG
Sonny Schelin. 2002. Mediating transurethral microwave thermotherapy by intraprostatic and periprostatic injections of Mepivacaine Epinephrine: Effects on treatment time, energy consumption, and patient comfort. Journal of Endourology, vol 16 pp 117-121. Mary Ann Liebert, Inc publishers
Sonny Schelin, Anders Claezon, Anders Sundin and Lennart Wagrell. 2004. Effects of intraprostatic and periprostatic injections of Mepivacaine Epinephrine on intraprostatic blood flow during transurethral microwave thermotherapy: Correlation with [15O]H20-PET. Journal of Endourology, vol 18 pp 965-970. Mary Ann Liebert, Inc. publishers
Sonny Schelin, Ulla Geertsen, Steen Walter, Anders Spångberg, Jens Duelund-Jacobsen, Kurt Kroyer, Hans Hjertberg, Vendil Vatne, Jonas Richthoff and Jörgen Nordling. . Feedback microwave thermotherapy vs TURP/prostate enucleation surgery in patients with benign prostatic hyperplasia and persistent urinary retention. (submitted)
Anders Mattiasson, Lennart Wagrell, Sonny Schelin, Jörgen Nordling, Jonas Richthoff, Bo Magnusson, Moddy Schain, Thayne Larson, Emmett Boyle, Jens Duelund-Jacobsen, Kurt Kroyer and Håkan Ageheim. . Five-year follow-up of feedback microwave thermotherapy versus TURP for clinical BPH: A prospective randomized multicenter study. (submitted)
id
030c2da4-47f6-446e-b869-c79e5533c98a (old id 546300)
date added to LUP
2016-04-01 15:43:35
date last changed
2019-05-21 20:56:52
@phdthesis{030c2da4-47f6-446e-b869-c79e5533c98a,
  abstract     = {{Abstract: The purpose of this thesis was to evaluate ProstaLund Feedback Treatment® (PLFT®) and the CoreTherm® device with regard to biophysics, mechanisms of action, treatment indications, additional techniques, efficacy and safety in the treatment of patients with benign prostatic hyperplasia (BPH). The application of two biophysical equations in the PLFT software is explained. The calculations provide the intraprostatic ?blood flow index? and amount of accumulated coagulation necrosis during treatment. The accuracy of the ?cell kill? calculations is compared to gadolinium-enhanced magnetic resonance imaging (MRI) and histology. The accumulated ?cell kill? monitored on-line during PLFT is considered a useful tool for helping the doctor to tailor the individual ?thermal dose? to each patient. The clinical efficacy, 1 and 5 years after PLFT and Trans-urethral Resection of the Prostate (TURP), is compared showing no statistically significant differences. Serious adverse events were more frequent after TURP. Expanded treatment indications for PLFT, to including patients with persistent urinary retention and patients with heavily enlarged prostates (&gt;100 g), were studied in a retrospective survey and in a prospective randomized multicentre study comparing PLFT with surgery (TURP and open surgery). Responder rate after PLFT was close to 80% and statistically equivalent to surgery after 6 months. Serious adverse events were less frequent after PLFT. The intraprostatic blood flow works like a heat sink by transporting heat away from the treatment area during thermotherapy. This is the explanation for the unpredictable outcome and frequent treatment failures described after low-energy transurethral microwave thermotherapy. High-energy TUMT can compensate for this in many ways but results in significant patient discomfort from micturition urge, burning sensations and pain.<br/><br>
<br/><br>
A new device, the Schelin Catheter®, makes it possible to inject and infiltrate the prostate by the transurethral route. Injections in several locations with local anaesthetics containing epinephrine have a twofold aim: 1) to minimize the intraprostatic blood flow and 2) to achieve good analgesia. Treatment time was reduced by 50% and the total energy required was reduced by 60% when using this technique. The effects of the epinephrine on the intraprostatic blood flow were also verified with positron emission tomography, [15O]H2O-PET.<br/><br>
<br/><br>
The results in this thesis show that the efficacy, safety and methodological improvements of PLFT now make it a challenger to surgery (TURP and open surgery) as a convenient, office based and more available option. This truly minimally invasive treatment is an attractive option for patients that can replace surgery for the majority of patients with clinical BPH. It also reduces the cost to the taxpayer.}},
  author       = {{Schelin, Sonny}},
  isbn         = {{91-628-6717-2}},
  issn         = {{1652-8220}},
  keywords     = {{nephrology; Urologi; nefrologi; Urology; PET; Schelin Catheter; epinephrine; local anaesthetics; microwave thermotherapy; intraprostatic blood flow; PLFT; Benign Prostatic Hyperplasia; intraprostatic temperature; CoreTherm}},
  language     = {{eng}},
  publisher    = {{Department of Urology, Clinical Sciences, Lund University}},
  school       = {{Lund University}},
  series       = {{Lund University Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Development of Feedback Microwave Thermotherapy in Symptomatic Benign Prostatic Hyperplasia.}},
  url          = {{https://lup.lub.lu.se/search/files/4458109/546310.pdf}},
  volume       = {{2006:25}},
  year         = {{2006}},
}