[Prevention of temporary prostatic obstruction after high-energy microwave thermothery by placement of prostatic bridge catheter]. / Prévention de l'obstruction prostatique temporaire après thermothérapie micro-ondes haute énergie par mise en place d'un tuteur prostatique.

ABSTRACT

OBJECTIVES: The clinical utility of a novel intraurethral prostatic bridge-catheter (PBC) was evaluated for prevention of temporary prostate obstruction following targeted high-energy transurethral microwave thermotherapy (TUMT) in patients with benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: High-energy TUMT was administered to 54 BPH patients under topical urethral anesthesia followed by placement of a PBC, which remained indwelling up to 1 month. Patient evaluation included determination of peak urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and quality of life (QOL) score at baseline, immediately following TUMT and PBC placement, and at periodic intervals thereafter up to 1 month. Results were compared retrospectively with those of 51 patients who underwent TUMT followed by standard temporary urinary catheterization, generally for 24 h. RESULTS: Immediately following TUMT and PBC placement significant improvements (p < 0.0005) were observed in mean Qmax, IPSS and QOL score of 59.3%, 33.5% and 23.6% respectively, compared with baseline values. Further improvements were demonstrable up to 1 month, at which time mean Qmax, IPSS and QOL score had improved 79.0%, 54.9% and 56.5%, respectively, vs baseline means (p < 0.0005). In a retrospective comparison at baseline and 14 days between PBC recipients (PBC group) and a cohort of TUMT patients who had undergone temporary standard catheterization and subsequent catheter removal (standard catheterization group), mean baseline Qmax, IPSS and QOL score were similar between the two groups. However, at the 14 day follow-up evaluation in the PBC group mean Qmax was 101.8% higher, and IPSS and QOL score were 47.9% and 51.1% lower, respectively, than the corresponding values in the standard catheterization group (p 0.0005). The PBC was well tolerated and remained in situ throughout the entire 1 month follow-up period in 48/54 (88.9%) patients. Early PBC removal was performed in 3/54 patients (5.6%) because of urinary retention and in 3/54 patients (5.6%) due to PBC migration. During the acute post-TUMT recovery period, PBC recipients experienced impairment in sexual function which, though statistically significant, was comparatively small in magnitude. CONCLUSION: PBC provides an efficacious and well-tolerated option for preventing prostatic obstruction in the acute post-TUMT period. This approach avoids the inconvenience and infection risk of standard indwelling catheters or intermittent self-catheterization. PBC insertion and removal are rapid, facile and non-traumatic. PBC placement may prove useful in improving the early results of TUMT.