Kastner Christof, Hochreiter Werner, Huidobro Christian, Cabezas Juan, Miller Paul
East Surrey Hospital, Redhill, United Kingdom.
Urology. 2004 Dec;64(6):1149-54. doi: 10.1016/j.urology.2004.07.016.
To evaluate the side effects, tolerability, and efficacy of transurethral microwave thermotherapy with urethral cooling (cooled TUMT) for chronic prostatitis/chronic pelvic pain syndrome in a prospective feasibility trial. Cooled TUMT, using the Targis system from Urologix, is an established treatment option for benign prostatic hyperplasia (BPH) with minimal side effects.
Patients with intractable chronic prostatitis/chronic pelvic pain syndrome and symptoms for more than 3 of the 6 months before treatment (National Institutes of Health-Chronic Prostatitis Symptom Index [NIH-CPSI] pain score of at least 8) were randomized to cooled TUMT at an intraprostatic temperature of either approximately 55 degrees C or approximately 70 degrees C. Tolerability, side effects, and efficacy were measured with standard diagnostic tests, including the NIH-CPSI. Subgroup analysis was performed to evaluate the effects with and without BPH comorbidity.
A total of 42 patients were included in the study; 39 patients successfully completed treatment and 35 completed follow-up through 12 months. The baseline versus 12-month mean NIH-CPSI score was total score 23.4 +/- 6.4 versus 11.5 +/- 10.2 (improvement in mean value of 51%), pain score 11.5 +/- 2.8 versus 4.6 +/- 4.9 (improvement in mean value of 60%), quality-of-life impact score 7.2 +/- 2.9 versus 3.8 +/- 3.8 (improvement in mean value of 47%; all P <0.0001), and urinary score 4.7 +/- 2.8 versus 3.1 +/- 3.0 (improvement in mean value of 34%; P = 0.0079). Treatment discomfort was within the ranges reported for patients with Targis-treated BPH. Two patients had reduced sperm motility. Side effects were minimal and transient, resolved spontaneously or with medication, and were similar regardless of treatment temperature or BPH comorbidity.
Cooled TUMT appears to be promising for intractable chronic prostatitis with or without BPH. Longer follow-up and a larger trial are required to evaluate the fertility impact and longer term durability further.
在一项前瞻性可行性试验中，评估经尿道微波热疗联合尿道冷却（冷却式经尿道微波热疗）治疗慢性前列腺炎/慢性盆腔疼痛综合征的副作用、耐受性和疗效。使用Urologix公司的Targis系统进行的冷却式经尿道微波热疗是治疗良性前列腺增生（BPH）的一种既定治疗选择，副作用极小。
将治疗前6个月中至少3个月有顽固性慢性前列腺炎/慢性盆腔疼痛综合征且有症状（美国国立卫生研究院慢性前列腺炎症状指数[NIH-CPSI]疼痛评分至少为8分）的患者随机分为前列腺内温度约为55摄氏度或约为70摄氏度的冷却式经尿道微波热疗组。通过包括NIH-CPSI在内的标准诊断测试来测量耐受性、副作用和疗效。进行亚组分析以评估合并或不合并BPH的影响。
共有42例患者纳入研究；39例患者成功完成治疗，35例患者完成了为期12个月的随访。基线时与12个月时的平均NIH-CPSI评分比较，总分分别为23.4±6.4和11.5±10.2（平均值改善51%），疼痛评分分别为11.5±2.8和4.6±4.9（平均值改善60%），生活质量影响评分分别为7.2±2.9和3.8±3.8（平均值改善47%；所有P<0.0OO1），排尿评分分别为4.7±2.8和3.1±3.0（平均值改善34%；P=0.0079）。治疗不适在Targis治疗的BPH患者报告的范围内。2例患者精子活力降低。副作用轻微且短暂，可自发缓解或通过药物缓解，无论治疗温度或是否合并BPH，副作用相似。
冷却式经尿道微波热疗对于合并或不合并BPH的顽固性慢性前列腺炎似乎很有前景。需要更长时间的随访和更大规模的试验来进一步评估对生育能力的影响和长期疗效。
