経尿道式高温度治療法による前立腺肥大症の単回治療成績 TRANSURETHRAL MICROWAVE THERMOTHERAPY FOR BENIGN PROSTATIC HYPERTROPHY
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経尿道式前立腺温熱治療器"プロスタトロン"を用いて31例の前立腺肥大症症例に高温度治療法を試み, 自覚的症状, 他覚的所見の変化を検討しその効果を判定した.<br>経尿道的に尿道前立腺部に挿入する22Fの治療用バルーンカテーテルはマイクロウエーブアンテナと冷却潅流回路を備えており, 高出力で前立腺内部を安全に加熱できる. 尿道内最高治療温度は43.3～45.5℃ (44.7±0.96℃: mean±S. D.) で平均出力は27.4Wattであった. 治療時間は単回, 1時間ですべて外来通院で行った. 1例には治療後尿閉が改善せずTURPを行い切除標本を組織学的に観察した. 尿道粘膜はよく保存定れているわりに前立腺組織内には, 間質の壊死性変化のみならず腺管腔内に脱落した萎縮腺上皮細胞も観察定れ, プロスタトロンによる温熱効果が組織学的に証明定れた. のこりの30例の効果判定は自覚的症状, 残尿量ならびに最大尿流量率を点数で表し治療後8週目で治療前の点数と比較した. 自覚的症状, 他覚的所見の両方とも点数の改善が認められたのは13例 (43.3%), 他覚的所見に改善がみられず自覚的症状のみが改善定れたものが14例, 自覚的症状 score が不変で他覚的所見 score が改善定れたもの2例, これらの症例を合計すると29例 (96.7%) になんらかの改善が認められた. 総合 score で, 25%以上 score が減少したものを『有効』, 24%未満10%以上を『やや有効』とすると有効率は各々53.3%, 37%であった.
Transurethral microwave thermotherapy using Prostatron was performed in 31 patients with benign prostatic hypertrophy, and the clinical effectiveness was evaluated by analyzing the subjective and objective responses following the treatment. The 22F balloon catheter to be placed in the prostatic urethra incorporates the microwave antenna, a cooling system and a fiberoptic thermosensor which allow an effective delivery of microwave energy to the center of the prostate, while preserving the mucosa and periurethral tissue. The maximum urethral temperature during the treatment ranged from 43.3 to 45.5°C (44.7±0.96°C: mean±S. D.) and the average power output was 27.4 Watt. The treatment was performed in a single session of an hour on the outpatient basis. In one patient who could not be relieved of the indwelling catheter underwent a transurethral resection, and the histological effect of thermotherapy on the resected specimen was examined. In the prostatic tissue, heat-induced necrotic change of the interstitial tissue as well as degenerative change of the acinar epithelium were remarkable, whereas the urethral mucosa was well preserved. In the remaining 30 patients, the clinical effects were evaluated 8 weeks after the treatment by a score scale for subjective symptoms, residual urine and maximum urinary flow rate, which was compared with the pretreatment score. Improvement of both subjective symptoms and objective findings was observed in 13 subjects (43.3%), that of subjective symptoms only in 14 cases, and that of objective findings only in 2 cases, resulting in a notable improvement in total 29 cases (97.7%). When post-treatment total score decreased by 25% or more is categorized as “excellent”, and 24-10% as “fair”, the clinical effectiveness (excellent & fair) was 53.3 and 37%, respectively. Throughout the follow-up period, not a single case presented such severe adverse effects as fever, infection and urethral stenosis. Due to the acute local edema caused by the thermotherapy, 3 patients noted transient urinary retention, but it was resolved by indwelling a catheter for a few days.<br>It is concluded that the thermotherapy by Prostatron is safe and effective, and can be applied to patients with symptomatic benign prostatic hypertrophy who are reluctant to undergoing surgery.
- The Japanese Journal of Urology
The Japanese Journal of Urology 82(12), 1916-1923, 1991
The Japanese Urological Association