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At least 199 records · Page 11Linked to original sources
PubMed1996

Transurethral balloon laser thermotherapy: effects of a directionally shielded balloon in canine prostates.

BACKGROUND: Transurethral balloon laser thermotherapy (TUBAL-T) improves objective, but not subjective, symptoms of benign prostatic hyperplasia (BPH). We studied whether or not an Nd:YAG laser beam with a shielded balloon could successfully irradiate the prostate during TUBAL-T in selective manner, to improve the subjective symptoms. METHODS: TUBAL-T was performed on canine prostates using the balloon with a laser probe, which was shielded anteriorly at 90 degrees (from the center of the balloon) and posteriorly at 90 degrees. RESULTS: At 20 watts laser power, the relative power density in the bilateral non-shielded areas was 17.4 and 17.8, and in the shielded area it was 1.0. Observation by thermography revealed that the temperature after laser radiation in a non-shielded area of a fish cake phantom was higher than in a shielded area. Following transurethral thermotherapy using a shielded balloon in dogs, a cavity was formed bilaterally around the urethra, and the tissues at the anteroposterior sides and the urethra were preserved. CONCLUSIONS: TUBAL-T, which has been performed in clinical cases of benign prostatic hyperplasia, might be useful in selective irradiation of adenoma if a shielded balloon is used.

Animals↗
PubMed1997

Transurethral balloon laser thermotherapy for urinary retention in patients with benign prostatic hyperplasia who are at high surgical risk.

BACKGROUND: Twelve patients with benign prostatic hyperplasia and urinary retention, who were considered to be poor candidates for prostatectomy, were treated by transurethral balloon laser thermotherapy (TUBAL-T). The mean patient age was 78.9 years (range, 66 to 93 years) and the mean duration of bladder catheterization was 11 weeks (range, 2 to 48 weeks). METHODS: Irradiation into the prostatic tissue was done through 360 degrees with a neodymium: yttrium aluminum garnet (Nd:YAG) laser balloon placed in the prostatic urethra, with pain relief provided by using local topical anesthesia. The total laser dose was from 45,000 to 123,376 J, with an average of 73,089 J. The irradiation time was from 40 to 54 minutes, with an average of 45.2 minutes. RESULTS: Spontaneous voiding became possible in all patients at a mean of 2.8 days (range, 1 to 7 days) after irradiation. The mean catheter-free period was 20.5 months (range, 6 to 34 months), with the longest being 34 months. The international prostatic symptom scores, quality-of-life scores, and peak uroflow rates showed substantial improvement after laser thermotherapy. To date, long-term resumption of spontaneous voiding was successfully achieved in 9 of 12 cases (75%). CONCLUSION: TUBAL-T is safe and effective alternative for treatment of urinary retention in patients with benign prostatic hyperplasia who are considered to be at high surgical risk.

Aged↗
PubMed2004

Transpupillary thermotherapy for the treatment of subfoveal choroidal neovascularization associated with age-related macular degeneration.

OBJECTIVE: To evaluate the efficacy of transpupillary thermotherapy (TTT) for the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: Prospective, non-randomized, non-masked, case-selected series. METHODS: All patients with subfoveal CNV due to AMD and initial visual acuity (VA) between 6/9 and 6/60 were offered the opportunity to undergo TTT. Recruited subjects were treated using a diode laser (810 nm) with a beam size of 1.2-3.0 mm and power settings of 460-1200 mW. Treatment was applied for 60 seconds in a subthreshold manner. MAIN OUTCOME MEASURES: Differences in VA and changes in the angiographic appearance of CNV. RESULTS: Thirty-one occult/predominantly occult and five classic/predominantly classic membranes were treated with TTT and were followed-up for a mean of 6.0 +/- 1.2 months. Following an average of 1.5 +/- 0.7 (range 1-4) laser sessions, VA remained stable ( -1 to +1 Snellen line) in 24 (66.7%) eyes, improved by > 1 line in two (5.6%) eyes and decreased significantly (> or = 2 Snellen lines) in 10 (27.8%) eyes. Angiographically confirmed closure of CNV was detected in 22 (61.1%) patients. Membranes persisted in 11 (30.6%) eyes and recurred in three (8.3%) eyes. There was no association between reduction, elimination or persistence of angiographic leakage of CNV and change in VA after treatment (p = 0.347). CONCLUSIONS: Transpupillary thermotherapy may be effective at preserving vision and reducing CNV leakage in a number of patients with exudative AMD. Further studies are required to compare TTT with the natural course of subfoveal CNV and alternative treatment options.

Aged↗
PubMed2006

Transpupillary thermotherapy for the treatment of occult CNV in age-related macular degeneration: a prospective randomized controlled pilot study.

PURPOSE: To evaluate whether transpupillary thermotherapy (TTT) reduces the risk of moderate visual loss in patients with occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: A group of 25 patients were recruited and randomized into TTT or placebo groups. Patients were included if they had a subfoveal purely or predominantly (> 50%) occult CNV secondary to AMD with best corrected visual acuity (BCVA) of 6/60 or better and the lesion was not larger than 4.5 mm. Treatment was carried out using an 810-nm Oculight diode laser with a fixed spot size covering the whole lesion according to the standard protocol. The same procedure was used for the control group, except that the power was set at zero. The patients were followed up at 6 weeks, 3 months and then every 6 months for up to 2 years. A maximum of three treatments were administered in both groups if there was evidence of persistent leakage from CNV. RESULTS: At the 12-month follow-up, there was no significant difference in the mean values for BCVA distance and near or contrast sensitivity between the treatment and control groups. The Mann-Whitney test was used to assess the differences in BCVA and contrast sensitivity between the groups, both at baseline and at the 12-month follow-up. No statistically significant difference was found; both groups lost on average two lines of BCVA. CONCLUSION: Transpupillary thermotherapy appeared to have been of no benefit in preventing further visual loss in patients with occult CNV in this pilot study.

Aged↗
PubMed2003

Thermomechanical analysis of soft-tissue thermotherapy.

Soft-tissue thermotherapy based on sub-ablative heating of collagenous tissues finds wide-spread application in medicine such as tissue welding, thermokeratoplasty, skin resurfacing, elimination of discogenic pain in the spine and treatment of joint instability. In this paper, heat-induced thermomechanical response characteristics of collagenous tissues are quantified by means of in vitro experimentation with a representative model tissue (New Zealand white rabbit patellar tendon). Three distinct heat-induced thermomechanical response regimes (defined by the rate of deformation and the variation of material properties) are identified. Arrhenius damage integral representation of collagenous tissue thermal history is shown to be adequate in establishing the master response curves for quantification of thermomechanical response for modeling purposes. The trade-off between the improved kinematical stability and compromised mechanical stability of the heated collagenous tissue is shown to be the major challenge hindering the success of subablative thermotherapies.

Adaptation, Physiological↗
PubMed2001

Transpupillary thermotherapy (TTT) for the treatment of choroidal neovascularisation.

AIM: To assess the effectiveness of transpupillary thermotherapy (TTT) for the treatment of classic and occult choroidal neovascularisation (CNV). METHOD: In a retrospective, case selected, open label trial 44 eyes of 42 patients with CNV secondary to age related macular degeneration (ARMD) were studied. 44 eyes with angiographically defined CNV were treated with diode laser (810 nm) TTT. Laser beam sizes ranged between 0.8 and 3.0 mm and power settings between 250-750 mW. Treatment was given in one area for 1 minute, the end point being no visible change, or a slight greying of the retina. Outcome was assessed with Snellen visual acuity and clinical examination; in 24/44 patients angiographic follow up was available. RESULTS: 12 predominantly classic CNV and 32 predominantly occult membranes were followed up for a mean of 6.1 months (range 2-19). Mean change in vision for classic membranes was -0.75 (SD 1.75) Snellen lines and occult membranes was -0.66 Snellen lines (2.1) (p>0.05). Predominantly classic membranes were closed in 75% (95% CI: 62.5-87.5) of eyes, remained persistent in 25% (95% CI: 12.5-37.5); no recurrences occurred. Predominantly occult membranes were closed in 78% (95% CI: 70.1-85.3) of eyes, remained persistent in 12.5% (95% CI: 6.6-18.5), and were recurrent in 5.1% (95% CI: 4.2-14.3). CONCLUSIONS: Transpupillary thermotherapy is a potential treatment for CNV. It is able to close choroidal neovascularisation while maintaining visual function in patients with classic and occult disease. Further trials of TTT are needed to compare this intervention with the natural history and other treatment modalities.

Aged↗
PubMed1995

Malignant liver tumors treated with MR imaging-guided laser-induced thermotherapy: technique and prospective results.

PURPOSE: To evaluate magnetic resonance (MR) imaging-guided laser-induced thermotherapy (LITT) of liver metastases. MATERIALS AND METHODS: In a phase II study, 20 patients with 33 metastases from colorectal carcinoma (75%) or other primary tumors (25%) underwent LITT. MR thermometry performed with fast low-angle shot sequences was used to monitor therapy on-line, and dynamic and static contrast material-enhanced MR images enabled estimation of the degree of resultant necrosis. Follow-up studies were performed 3 months after thermotherapy. RESULTS: The thermosequences enabled accurate on-line monitoring in 85% of lesions. In 69% of lesions 20 mm in diameter or smaller, contrast-enhanced MR images depicted substantial necrosis, with a local tumor control rate of 69% after 6 months and 44% after 12 months. Among lesions larger than 20 mm, necrosis was frequently incomplete, with a local control rate of only 41% after 6 months and 27% after 12 months. CONCLUSION: MR imaging-guided LITT of liver metastases is a safe and promising therapy for liver metastases.

Adult↗
PubMed2000

Tolerability of 3.5 versus 2.5 high-energy transurethral microwave thermotherapy.

PURPOSE: To evaluate the tolerability of high-energy microwave thermotherapy in patients with benign prostatic hyperplasia (BPH) using two different treatment protocols (Prostasoft 2.5 and Prostasoft 3.5). MATERIALS AND METHODS: Pain and discomfort during treatment was evaluated using a visual analog scale in 39 patients undergoing 60-min Prostasoft 2.5 treatment and 41 patients undergoing 30-min Prostasoft 3.5 treatment. The duration of transurethral microwave thermotherapy (TUMT) 3.5 treatment is significantly shorter than TUMT 2.5 treatment. RESULTS: The pain level is significantly higher at the beginning of the Prostasoft 3.5 treatment compared to the Prostasoft 2.5 treatment. The reported pain level becomes similar 10 min into treatment, and remains similar to the end of the 3.5 treatment (at 30 min), when the pain level returns to baseline. The 2.5 protocol patients experience continuously increasing pain until the end of the treatment at 60 min. One minute following termination of treatment, the pain level drops back to the baseline level. No correlation between the level of pain and the baseline subjective or objective voiding parameters was observed. A correlation is also absent between the pain level, age and catheterization time. There only seems to be a weak correlation between the pain level and TUMT energy in the Prostasoft 2.5 treatment group. CONCLUSIONS: Both TUMT 2.5 and TUMT 3.5 are well tolerated. Even though patients undergoing TUMT 3.5 treatment experience more discomfort initially, the ultimate discomfort is similar to the TUMT 2.5 treatment, during the first 30 min. Shortening of treatment time significantly reduces the pain and discomfort experienced by the patient. Pretreatment parameters are not predictors of the pain level experienced.

Aged↗
PubMed2003

High-energy microwave thermotherapy in the treatment of benign prostatic hyperplasia.

INTRODUCTION: Transurethral microwave thermotherapy is an anesthesia-free, outpatient method of treating lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Our results with the use of this technique in 25 patients are reported. MATERIALS AND METHODS: Twenty-five patients with BPH, 8 of whom with complete urinary retention, were treated with high-energy transurethral microwave thermotherapy (HE-TUMT) (Prostatron system). Preoperative investigations included digital rectal examination, urinary free flow rate, PSA, urinalysis, urine culture, transrectal ultrasonography, urodynamic evaluation, International Prostatic Symptom Score (IPSS) and quality of life (QoL). Main selection criteria included: large prostate, high surgical risk, reluctance to undergo surgery. All patients were obstructed according to the Abrams-Griffith's nomogram. For the statistical analysis a repeated-measures, one-way ANOVA was performed on previously non-catheterized patients. RESULTS: Six of the 8 patients with catheter before treatment were able to urinate spontaneously with no significant post-voiding residual urine. In the 17 remaining patients, IPSS decreased from a mean of 18.5 at baseline to 7.30 and QoL from a mean of 3.9 to 1.2. Mean maximum flow rates during uroflowmetry increased from 8.5 to 16.9 ml/s. P(det) Q(max) decreased from a mean of 83.0 cm H(2)O at baseline to 50.7 cm H(2)O and Q(max) increased from a mean of 6.8 ml/s at baseline to 15.1 ml/s during the pressure-flow study. After TUMT, 13 patients were unobstructed and 4 equivocal according to the Abrams-Griffith's nomogram. CONCLUSION: Our study performed in a selected population of patients with BPH documents the efficiency and safety of HE-TUMT. This technique appears to be a valid therapeutic option, particularly in patients with high surgical risk.

Aged↗
PubMedDate not supplied

Transurethral microwave thermotherapy for treatment of benign prostatic hyperplasia: a preliminary assessment of the Prostalund feedback treatment machine.

OBJECTIVE: The aim of this preliminary study was to evaluate the efficacy of Prostalund feedback treatment (PLFT) using microwave thermotherapy equipment for benign prostate hyperplasia (BPH) in patients with urinary retention and an indwelling urethral catheter. SUBJECTS AND METHODS: Four unselected patients, 51-68 years old (mean age 60 years), with urinary retention and an indwelling catheter were treated with PLFT under local anaesthesia and sedation. They were considered high-risk patients for treatment by transurethral resection of the prostate (TURP) under spinal or general anaesthesia. Initial assessment included prostate-specific antigen, determination of prostate volume and exclusion of prostate cancer using transrectal ultrasound (TRUS). The patients had the indwelling catheter for 1-2 weeks prior to treatment, the urethral catheters were removed 10-12 days after PLFT. Two patients who failed to void after transurethral microwave thermotherapy underwent urodynamic study to determine the reason for failure. RESULT: The mean volume of the treated prostate gland was 75.50 cm3 (range 51-150 cm3). Two of the 4 patients were successfully relieved of their indwelling catheter with satisfactory peak flow, residual urine and symptom score, while treatment failed in the remaining 2. The reasons for the failure were identified as a small bladder capacity and neurogenic bladder in a diabetic patient and the presence of a middle lobe with large protruding lateral lobes into the bladder of the other patient. The latter patient had a prostate volume of 150 cm3. 'Salvage' TURP in both patients revealed that PLFT caused extensive necrosis of prostatic tissue and the TURP was then accomplished with minimal blood loss (<200 ml) even in the patient with 150-gram prostate. There were no serious complications such as bleeding, sepsis, rectoprostatic fistula or urine incontinence. CONCLUSION: The result of this preliminary investigation appears to be satisfactory and indicates that PLFT could be a good, minimally invasive alternative to surgery for BPH patients with retention of urine and an indwelling catheter.

Aged↗
PubMed1993

Clinical response to transurethral microwave thermotherapy is thermal dose dependent.

Transurethral microwave thermotherapy of the prostate was used to treat men with symptomatic benign prostatic hypertrophy. Three treatment protocols delivering increasing thermal doses (Prostasoft T-A > Prostasoft II > Prostasoft I) were evaluated. The results show a dose-dependent response. Histological changes induced by microwave heating were dependent on the temperature achieved in the tissue. Thermocoagulation is obtained above 45 degrees C and thermoablation above 60 degrees C. Using Prostasoft II in a long-term follow-up study, the Madsen symptom score decreased by 66% and peak flow rates increased by 41% over a period of more than 18 months. Using Prostasoft T-A (thermoablation) in 28 patients, a cavity was obtained inside the prostate without major complication. The symptoms and obstruction caused by benign prostatic hypertrophy can be treated by transurethral thermotherapy in a single, anesthesia-free 1-hour session on an ambulatory basis.

Follow-Up Studies↗
PubMed1993

Transurethral microwave thermotherapy in the treatment of symptomatic benign prostatic hyperplasia.

One hundred and forty-four patients with symptomatic benign prostatic hyperplasia were treated by transurethral microwave thermotherapy between January and December 1991. Before entering the study, all patients had a Boyarsky symptom score > or = 8, peak flow rate < or = 15 ml/s and postvoiding residual urine < or = 200 ml. Transurethral thermotherapy with the Prostatron (Technomed) was carried out as a single session (60 min) without any analgesia or sedation. Acute urinary retention occurred in 19.4% of the patients after treatment requiring catheterization for 2-3 weeks; morbidity rate was 5.5%. Six months after treatment, Boyarsky symptom score decreased from 11.73 +/- 4.97 to 4.40 +/- 3.21 (mean values +/- SD); peak flow rate increased on average from 8.97 +/- 4.18 to 13.07 +/- 4.87 ml/s and postvoiding residual urine decreased from 135 +/- 17.9 to 63 +/- 34.7 ml. Slight further improvement was shown, in a few patients, at the 1-year follow-up visit.

Catheterization↗
PubMed1993

Transurethral radio frequency thermotherapy for symptomatic benign prostatic hyperplasia.

A total of 90 patients with symptomatic benign prostatic hyperplasia (BPH) were treated with transurethral radio frequency thermotherapy. The treatment consisted of one 180-min session at 48 degrees C. All patients were evaluated before treatment and 80 (10 with urinary retention) were reevaluated at 3 months for follow-up. The analysis of the results of this group of patients is the subject of this presentation. Results were defined according to the variation in three parameters: nocturia, symptomatic score (Madsen) and urinary peak flow. Improvement (defined as a change of 50% or more in any of the three measured parameters) was found in 78% of the patients. Improvement in all of the above-mentioned parameters was found in 34.08% of the patients. In 29.82% of the patients improvement was found in two parameters and 14.02% of the patients improvement was found in one parameter and none in 21.30%. The percent variations in each parameter before and after treatment were: nocturia and symptom score decreased by 33.33% and 50%, respectively, and urinary peak flow increased by 33.65%. Age was the most important predictive factor. Of the patients under 65 years of age, 85% showed very good and good results. In comparison, only 42% of the patients over 65 years showed similar results. Immediate complications were 4 cases of acute urinary retention (5.71%) and 4 cases of urinary infection (5.71%). Transurethral radio frequency thermotherapy, having a low toxicity and complication rate, has comparable results to other nonsurgical treatment modalities. It is a viable alternative treatment for symptomatic BPH.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2002

[Numerical modeling of ultrasound thermotherapy].

In ultrasound thermotherapy (USTT) high intensity focused ultrasound (HIFU) is used for noninvasive thermal treatment of human tissue deep inside the body. In this paper a FDTD-model is presented to simulate USTT. It combines nonlinear ultrasound propagation and broadband tissue attenuation together with the bio-heat transfer equation for calculation of temperature distribution in tissue. The temperature dependence of parameters is integrated in the complete model. Simulation results demonstrate the potentialities of this simulation tool to analyze and optimize thermotherapy.

Body Temperature↗
PubMed2006

Effect of laser-induced thermotherapy on liver metastases.

Laser-induced thermotherapy, or laser ablation, is an established minimally invasive percutaneous technique of tumor ablation. It is performed routinely in hepatic tumors and in other indications. Most patients treated with laser-induced thermotherapy suffer from liver metastases from primary tumors, particularly colorectal cancer. In this review, the local control rate, including morphological response and local recurrence, is evaluated. Survival data, including median survival time and 1-, 2- and 3-year survival, are discussed; treatment complications are also explored. The method of treatment performance and evaluation, results, and the authors' views on the current status of treatment are outlined.

Contraindications↗
PubMed1996

Serum concentrations of prostate-specific antigen after diagnostic procedures and transurethral microwave thermotherapy of benign prostatic hyperplasia.

The objective was to study the effects of diagnostic and therapeutic procedures on serum prostate-specific antigen (PSA) concentration. Urethrocystoscopy in combination with digital rectal examination was followed by a moderate increase of serum PSA for 7-10 days. At 1 day after transurethral microwave thermotherapy (TUMT), an acute and pronounced effect on PSA was observed, which returned to baseline level after 4 weeks. The initial rise in serum PSA corresponded to a PSA density of 1.11, compared to 0.07 at baseline. The present data should be taken into consideration in conjunction with endoscopic evaluation of the lower urinary tract. Additionally, the acute effect on PSA after TUMT strongly suggests the ability of thermotherapy to induce cellular injury and death. One-year follow-up, however, was associated with increased PSA levels, indicating that only a minor part of the PSA-producing compartment was lost in the acute phase.

Aged↗
PubMed1996

Transurethral microwave thermotherapy for benign prostatic hyperplasia. Subjective response and urodynamic changes.

Results of transurethral microwave thermotherapy for benign prostatic hyperplasia were good after 1 year in 68% of 66 cases. Despite good correlation between subjective assessment of results and improvement in urodynamic parameters, no predictive factors for probably successful outcome could be identified. Diminution in frequency of micturition (diurnal from 8.8 to 6.8 times, nocturnal from 3.0 to 1.6 times), increased flow rates (Q max from 8.8 to 14.2 ml/s) and reduction of detrusor pressures during voiding (Pdet max from 86.9 to 75.0 cm H2O) were significant, but the change in residual volume (from 52 to 37 ml) was of lesser degree (all mean values). Transurethral microwave thermotherapy can be tried for relief of moderate obstruction when transurethral prostatic resection involves risk, or the patient himself requests noninvasive treatment.

Aged↗
PubMedDate not supplied

Measurements of the thermal focus of an experimental focused ultrasound thermotherapy system.

The thermal focus of an experimental thermotherapy equipment based on high energy focused ultrasound has been investigated. The in-house built equipment has a treatment head of seven separate focused transducers arranged in a semispherical fixture with a common focus at 100 mm from the transducer surfaces. Each transducer has a diameter of 50 mm and operates at 0.5 MHz. The ultrasound field of this seven-transducer arrangement, as well as of a single transducer of the same type as the ones in the arrangement, has been investigated in terms of temperature distribution evolved by absorption in castor oil. The results of the single transducer measurements show an ellipsoid-shaped focus displaced from the geometrical focus towards the transducer, whereas the measurements of the treatment head show a thermal focus which practically coincides with the geometrical one. Differences in location and shape of the thermal focuses depend on differences in the focusing action and the absorption in the media. Pilot investigations on tissue lesioning in vitro on pig muscle samples and in vivo on pig thigh were also carried out. Well discriminated local lesions with ellipsoid shape were obtained in the experiments in vitro and in vivo. Temperatures of up to 80 degrees C were measured in tissue at the focus in vitro. The results show that the equipment is well suited for thermotherapy applications.

Animals↗