title: High-energy feedback microwave thermotherapy and intraprostatic injections of mepivacaine and adrenaline: an evaluation of calculated cell kill accuracy and responder rate.
abstract: OBJECTIVE
  The aim of this study was to evaluate cell kill accuracy and responder rate when using injections of intraprostatic mepivacaine and adrenaline (MA) before high-energy microwave thermotherapy (HE-TUMT).
  
  
  METHODS
  This retrospective evaluation encompassed 283 treatments in men with lower urinary tract symptoms or urinary retention due to benign prostatic hyperplasia. They were treated consecutively during 2003-2008 using HE-TUMT with a feedback technique. Immediately before treatment, MA was administered into the prostate via a Schelin Catheter®. Clinical outcome was evaluated 3 months after treatment using a validated symptom score, transrectal ultrasound, peak urinary flow and postvoid residual.
  
  
  RESULTS
  Systematic underestimation of the resulting coagulation necrosis was a consistent finding when using MA, a calculated cell kill of 21% yielding a volume reduction of 26% for prostate volumes less than 100 ml and 31% for prostate volumes greater than or equal to 100 ml. Mean prostate volume was 74 ml and mean treatment time was 13 min. Less than 1% of the patients needed analgesics or sedatives on demand. Analysis of the data showed an estimated clinical responder rate of approximately 87%.
  
  
  CONCLUSIONS
  The resulting prostate volume reduction corresponds to the earlier empirically recommended 30% cell kill for CoreTherm® without MA. The treatment concept combining CoreTherm with intraprostatic injections of MA corresponds to the clinical outcome of thermotherapy without MA, with the benefits of reduced pain, shortened treatment time and decreased energy consumption.
authors: Department of Urology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg , Göteborg , Sweden.
authors: Fredrik
authors: F
authors: Stenmark
authors: Lars
authors: L
authors: Brudin
authors: Johan
authors: J
authors: Stranne
authors: Ralph
authors: R
authors: Peeker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016923:Cell Death; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000628:therapy*; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009929:Organ Size; D011467:Prostate / Q000473:pathology; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000473:pathology; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome; D016055:Urinary Retention / Q000209:etiology / Q000628:therapy*
chemical_list: D008619:Mepivacaine; D004837:Epinephrine
keywords: Adrenaline; benign prostatic hyperplasia; intraprostatic injection; mepivacaine; microwave thermotherapy