ProstatronTMによる前立腺高温度治療後に広範なCavity formationを認めた2例

Abstract

1993年3月以降前立腺肥大症患者40例で本装置(Prostasoft 2, 最大出力50ワット, 尿道内最高温度44.5℃, 直腸内最高温度42.5℃)を用いて治療を行い, 中2例で前立腺部尿道を含む広範な前立腺の壊死脱落を認めた.1例で採取した壊死組織は組織学的には熱によると思われる変性壊死であった.両例共, 術後3或いは1ヵ月間著明な排尿困難を示したが, 以後排尿状態は著しく改善した.術後3或いは4ヵ月目の尿道造影でcavity形成を認め, 1例では精嚢への造影剤の逆流を認めた.共に, 外尿道括約筋, 直腸の損傷は認めなかった

The Prostatron device, developed by Dr. Devonec, provides microwave heating of the prostate and simultaneous conductive cooling of the urethra. Treatment with Prostatron (transurethral microwave thermotherapy: TUMT) of BPH can be performed in a single session, and the urethra, the rectum and the surrounding tissue are protected with the temperature monitoring system. TUMT with Prostatron may be more suitable for a small adenoma with mild symptoms than a large adenoma with severe symptoms, because objective improvement is rarely observed compared with subjective improvement. We have treated 40 cases of BPH with Prostatron (Prostasoft 2, max. energy: 50 watt, max. urethral temperature: 44.5 degrees C, max. rectal temperature: 42.5 degrees C) since March 1993. Among them, there were 2 cases of large cavity formation involving the prostatic urethra. With cavity formation, TUMT may have its place in the treatment of a large adenoma with severe urinary symptoms, but loses its advantage in the prevention of persistent urinary infection and retrograde ejaculation, especially in the treatment of a small adenoma in a younger patient with mild urinary symptoms. It is unknown why such cavity formation occurred only in 2 patients among 40 equally treated cases, but the causes of cavity formation and safety of TUMT should be evaluated again, even though no injury to the rectum and the external urethral sphincter were detected. We report these 2 cases, and causes of cavity formation and discuss the prospects of TUMT.