Effect of Wheat Cultivars and Blends on the Oviposition and Larval Mortality of Cephus cinctus (Hymenoptera: Cephidae) and Parasitism by Bracon cephi (Hymenoptera: Braconidae).

The wheat stem sawfly (Cephus cinctus Norton) is a major historical pest of wheat in the northern Great Plains of North America. The insect spends most of its life as a larva protected inside grass stems so that its management has relied on strategies other than insecticides. We conducted a study in southern Alberta from 2006-2009 to assess the effects of wheat species, cultivar, seeding rate, and blending a resistant and a vulnerable cultivar, on oviposition, larval infestation, and cutting damage. The mortality caused by its primary parasitoid, Bracon cephi (Gahan), was also assessed to investigate the potential benefit of cultivar blends to enhance sawfly biological control. Sawfly laid fewer eggs on plants of the durum cultivar 'AC Avonlea' and on those of the solid-stemmed cultivar 'Lillian' compared to plants of the hollow-stemmed cultivar 'CDC Go.' Larval establishments (infestation) followed a similar pattern to that of oviposition. At these locations there was low cutting damage in most years and to a large extent this was due to mortality inflicted by the parasitoid Bracon cephi (40-60%). However, the remaining mortality was attributed to other factors and host, particularly the inclusion of the solid-stemmed cultivar. Direct and indirect factors likely affected the success of the parasitoid in the crop monocultures and blends, and these mechanisms require further research.

A novel temporary prostatic stent for the relief of prostatic urethral obstruction.

OBJECTIVES: To determine the effect of a novel temporary prostatic stent (The Spanner, AbbeyMoor Medical, Inc., Minnesota, USA) on variables of voiding function and quality of life among patients with prostatic urethral obstruction. PATIENTS AND METHODS: The stent design is very similar to the proximal 4-6 cm of a Foley catheter; this includes a proximal balloon to prevent distal displacement, a urine port situated cephalad to the balloon, and a reinforced stent of various lengths to span most of the prostatic urethra. There is also a distal anchor mechanism attached by sutures, and a retrieval suture which extends to the meatus and deflates the proximal balloon when pulled. The stent was inserted under topical anaesthesia in 30 patients. The maximum flow rate (Qmax), voided volume (W), postvoid residual (PVR), the International Prostate Symptom Score (IPSS) and stent position were assessed. RESULTS: Stents remained in situ for a mean (range) of 57 (1-98) days. The mean overall Qmax at baseline and after insertion were 8.2 and 11.6 mL/s, representing a 42% improvement (P < 0.001); the respective mean overall Ws were similar, at 219.7 and 221.6 mL (0.9% increase, not significant) and the PVRs were 312.1 and 112.3 mL, representing a 64% decrease (P = 0.004). The overall mean IPSS declined from 22.3 before to 7.1 after insertion, representing a 68% decrease (P < 0.001). There were only minor adverse events. The stability, patency and lack of migration of the device were confirmed radiographically up to 12 weeks of use. CONCLUSIONS: This early study shows that this temporary prostatic stent is easily inserted and removed, remains anchored in position, and significantly improves the Qmax, PVR and IPSS while preserving volitional voiding and continence.

Acyl-CoA measurements in plants suggest a role in regulating various cellular processes.

Acyl-CoA esters have been shown to be involved in regulating metabolism and cell signalling in bacteria, yeast and mammalian cells, but little is known about their role in plants. Using a new method for the sensitive detection and quantification of acyl-CoA esters, we have recently shown that acyl-CoA pools can be dramatically altered in transgenic oilseed rape embryos, engineered to produce medium-chain fatty acids, and in mutant Arabidopsis seedlings that are unable to mobilize storage lipid. The consequences of these alterations are discussed in the context of oil yield and organelle biogenesis and the possible role of acyl-CoAs in regulating these processes.

Requirement for 3-ketoacyl-CoA thiolase-2 in peroxisome development, fatty acid beta-oxidation and breakdown of triacylglycerol in lipid bodies of Arabidopsis seedlings.

3-ketoacyl-CoA thiolase (KAT) (EC: 2.3.1.16) catalyses a key step in fatty acid beta-oxidation. Expression of the Arabidopsis thaliana KAT gene on chromosome 2 (KAT2), which encodes a peroxisomal thiolase, is activated in early seedling growth. We identified a T-DNA insertion in this gene which abolishes its expression and eliminates most of the thiolase activity in seedlings. In the homozygous kat2 mutant, seedling growth is dependent upon exogenous sugar, and storage triacylglycerol (TAG) and lipid bodies persist in green cotyledons. The peroxisomes in cotyledons of kat2 seedlings are very large, the total peroxisomal compartment is dramatically increased, and some peroxisomes contain unusual membrane inclusions. The size and number of plastids and mitochondria are also modified. Long-chain (C16 to C20) fatty acyl-CoAs accumulate in kat2 seedlings, indicating that the mutant lacks long-chain thiolase activity. In addition, extracts from kat2 seedlings have significantly decreased activity with aceto-acetyl CoA, and KAT2 appears to be the only thiolase gene expressed at significant levels during germination and seedling growth, indicating that KAT2 has broad substrate specificity. The kat2 phenotype can be complemented by KAT2 or KAT5 cDNAs driven by the CaMV 35S promoter, showing that these enzymes are functionally equivalent, but that expression of the KAT5 gene in seedlings is too low for effective catabolism of TAG. By comparison with glyoxylate cycle mutants, it is concluded that while gluconeogenesis from fatty acids is not absolutely required to support Arabidopsis seedling growth, peroxisomal beta-oxidation is essential, which is in turn required for breakdown of TAG in lipid bodies.

Use of a transurethral microwave thermotherapeutic device with permanent pacemakers and implantable defibrillators.

OBJECTIVE: To determine whether a device (Urologix Targis system) used for transurethral microwave treatment interferes with sensing, pacing, and arrhythmia detection by permanent pacemakers and implantable cardioverter-defibrillators (ICDs). METHODS: We tested 13 pacemakers in both bipolar and unipolar sensing configurations and 8 ICDs in vitro. Pacemakers and ICDs were programmed to their most sensitive settings. Energy outputs of the microwave device were typical of those used clinically. The probe of the microwave device was anchored 1.2 cm from the pacemaker or ICD being tested. RESULTS: No sensing, pacing, or arrhythmic interactions were noted with any ICD or any pacemaker programmed to the bipolar configuration. One pacemaker (Guidant Vigor 1230) showed intermittent tracking when programmed to the unipolar configuration. CONCLUSIONS: Most patients with permanent pacemakers or ICDs can safely undergo transurethral microwave therapy using the device tested. Pacemakers and ICDs should be programmed to the bipolar configuration (if available) during therapy. The pacemaker or ICD should be interrogated before and after therapy to determine whether programming changes occurred as a result of treatment. However, our findings suggest that this is unlikely.

Technical Advance: a novel technique for the sensitive quantification of acyl CoA esters from plant tissues.

We report a novel, highly sensitive and selective method for the extraction and quantification of acyl CoA esters from plant tissues. The method detects acyl CoA esters with acyl chain lengths from C4 to C20 down to concentrations as low as 6 fmol in extracts. Acyl CoA esters from standard solutions or plant extracts were derived to their fluorescent acyl etheno CoA esters in the presence of chloroacetaldehyde, separated by ion-paired reversed-phase high-performance liquid chromatography, and detected fluorometrically. This derivitization procedure circumvents the selectivity problems associated with previously published enzymatic methods, and methods that rely on acyl chain or thiol group modification for acyl CoA ester detection. The formation of acyl etheno CoA esters was verified by mass spectrometry, which was also used to identify unknown peaks from chromatograms of plant extracts. Using this method, we report the composition and concentration of the acyl CoA pool during lipid synthesis in maturing Brassica napus seeds and during storage lipid breakdown in 2-day-old Arabidopsis thaliana seedlings. The concentrations measured were in the 3--6 microM range for both tissue types. We also demonstrate the utility of acyl CoA profiling in a transgenic B. napus line that has high levels of lauric acid. To our knowledge, this is the first time that reliable estimates of acyl CoA ester concentrations have been made for higher plants, and the ability to profile these metabolites provides a valuable new tool for the investigation of gene function.

Correlation between central zone perfusion defects on gadolinium-enhanced MRI and intraprostatic temperatures during transurethral microwave thermotherapy.

BACKGROUND AND PURPOSE: The likelihood of success of thermoablation of prostatic hyperplasia depends on delivering an optimal thermal dose, but data on the temperatures achieved with these methods are few. We sought to develop a noninvasive method for monitoring intraprostatic heat distribution. PATIENTS AND METHODS: Thirteen patients ranging from 50 to 76 (mean 61.3+/-8.1) years were enrolled in this study, all of whom had evidence of obstruction by uroflowmetry and pressure-flow studies. The mean total volume of the gland was 40.3+/-13.1 cc, while the mean adenoma volume was 20.4+/-10.1 cc, as estimated by preoperative transrectal ultrasonography. All the patients were treated with the Urologix Targis device for at least 45 minutes. Continuous temperature mapping was performed during the therapy using spatially dispersed thermosensors at 16 prostatic sites. The patients were evaluated 5 to 12 days postoperatively with MRI of the prostate utilizing a pelvic phased-array coil at 1.5 T. RESULTS: Postprocedure MRI demonstrated a mean perfusion defect of 28.1+/-2.1% and 63.6+/-34% of the total gland and transition zone volumes, respectively. The mean anteroposterior (AP) and transverse diameters of the perfusion defects, as measured on the MRI images, were 29.2+/-5.2 mm and 32.7+/-5.9 mm, respectively. The maximum mean peak temperatures were 66.8+/-13 degrees C and were recorded at 4 mm from the urethra. No temperatures higher than 45 degrees C were recorded beyond 15 mm on either side of the urethra in the AP direction and beyond 16 mm on either side of the urethra in the transverse diameter. This perfusion defect was persistent for 27.7+/-5.2 mm in the superoinferior diameter, which is equivalent to the length of the antenna (28 mm). CONCLUSION: Perfusion defect diameters as measured by postprocedure MRI accurately represent the prostatic tissues exposed to temperatures of > or =45 degrees C for 45 minutes or more. So, MRI provides an accurate, noninvasive method for screening the effective heat pattern generated in the prostate during transurethral microwave thermotherapy.

Clinical results of microwave thermotherapy for benign prostatic hyperplasia.

Transurethral microwave thermotherapy is a truly office procedure without the need for anesthesia for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia. Several devices have been developed. Continuous refinement of the procedure led to higher energy protocols and high-intensity dose protocols applying the heat-shock strategy. We report on the clinical results of these protocols. Symptom scores improve around 60%, whereas maximum urinary flow rate improve from an average 9 to 10 mL/sec at baseline to 14 to 15 mL/sec during follow-up. No significant differences have been shown between the outcomes with the different devices. Long-term data show satisfactory results after 4 years. Initial clinical results with the heat-shock strategy show results comparable to those of higher-energy protocols with decreased morbidity. Treatment morbidity of higher energy protocols is moderate and consists mainly of the need for catheterization and a higher percentage of retrograde ejaculation. To improve treatment efficacy, patient selection appears to be most important. Prostate size, bladder outlet obstruction, age, and prostate composition are of predictive value for treatment outcome. Further development of the treatment protocols and refinement of the urethral applicators might enhance outcome.

Transurethral hot-water balloon thermoablation for benign prostatic hyperplasia: patient tolerance and pathologic findings.

OBJECTIVES: To determine the patient tolerance and thermal ablation pattern in human prostatic tissue after treatment with a hot water, catheter-based system. METHODS: Twenty-seven men scheduled for surgery for symptomatic benign prostatic hyperplasia or adenocarcinoma of the prostate underwent water-induced thermotherapy. The patients were randomly assigned to one of four treatment groups. Lidocaine gel was the sole means of pain control. The patients and an observer recorded patient discomfort during therapy. A Foley catheter was left in place until surgery (n = 13) or successful voiding (n = 14). Prostates were subsequently enucleated or removed, whole mounted, and examined. RESULTS: Patients reported mild treatment discomfort, the level of which did not correlate with the extent of necrosis, balloon diameter, or water temperature (all P >0. 05). Distal penile burning was the most commonly reported discomfort. All 14 patients successfully voided within 12 days of treatment. Prostates were enucleated (n = 24) or removed (n = 3) at a mean of 27 days (range 4 to 120) after thermotherapy, except for a single adenectomy 17 months after therapy. Pathologic findings included periurethral hemorrhagic necrosis, with focal or extensive urothelial denudation and mild inflammation. The mean maximal depth of necrosis from the urethral lumen was 7, 9, 10.33, and 11 mm in groups 1, 2, 3, and 4, respectively. The extent of necrosis was similar in all groups (P = 0.11), regardless of the water temperature; conversely, the balloon diameter correlated with the depth of necrosis (P = 0.024). CONCLUSIONS: This system of tissue ablation appears to be well tolerated, and it produced consistent pathologic results.

In vivo interstitial temperature mapping of the human prostate during cryosurgery with correlation to histopathologic outcomes.

OBJECTIVES: To determine the critical temperatures below which human prostatic tissue can be cryoablated in situ and the comparative cryoablative efficacy of single versus double-freeze cryosurgery. METHODS: Six patients with prostate cancer previously scheduled for prostatectomy underwent unilateral or bilateral cryosurgery using a single cryosurgery probe per hemiprostate. Intraprocedural interstitial prostatic temperatures were measured by thermocouple junctions placed at various radial distances from the probe. After subsequent prostatectomy, whole-mount sections of the prostate gland were subjected to histopathologic evaluation. RESULTS: Uniform coagulative necrosis was observed in proximity to the cryosurgery probe. The percentage of the prostate volume falling within the zone of necrosis produced by a single probe was significantly greater (P = 0.048) after a double freeze (median 13%; range 8% to 20%) than a single freeze (median 4%; range 0% to 12%). The critical temperature for cryoablation with a double freeze was -41.4 degrees C (95% confidence interval -49.9 degrees to -33.0 degrees C) compared with -61.7 degrees C (95% confidence interval -74.5 degrees to -48.9 degrees C) for a single freeze (P <0.0005). CONCLUSIONS: Uniform coagulative necrosis of human prostatic tissue in vivo can be accomplished throughout a significantly larger zone with a double freeze than with a single freeze. A double freeze at temperatures below approximately -40 degrees C results in necrosis. These findings provide a basis for more optimal use of temperature monitoring during cryosurgery, which is essential to ensure effective treatment of the entire prostate gland with minimum risk of damage to adjacent tissues such as the rectum and external sphincter.

Application of a new method for the sensitive detection and quantification of acyl-CoA esters in Arabidopsis thaliana seedlings and mature leaves.

We report a novel, highly sensitive and selective method for the detection and quantification of acyl-CoA esters from Arabidopsis thaliana. Extracted acyl-CoA esters were derived to their fluorescent acyl-etheno-CoA esters, separated by ion-paired reversed-phase HPLC, and detected fluorometrically. We report the composition and concentration of the acyl-CoA pool in mature A. thaliana leaves, and during storage-lipid breakdown in 2-day-old seedlings. The concentrations measured were in the 1-4 microM range for both tissue types. To our knowledge, this is the first time that reliable estimates of acyl-CoA ester concentrations have been made for plants.

Does transurethral microwave thermotherapy have a different effect on prostate cancer than on benign or hyperplastic tissue?

OBJECTIVES: Transurethral microwave thermotherapy is useful for the treatment of benign prostatic hyperplasia, but its effect on cancer is not documented. We analyzed the pathologic changes occurring after microwave thermotherapy in whole mount radical prostatectomy specimens from patients with cancer. METHODS: Nine patients scheduled for radical prostatectomy for clinically localized prostate cancer were treated with transurethral microwave thermotherapy (Urologix Targis System). Patients ranged in age from 64 to 72 years (mean 68). Seven patients underwent prostatectomy 4 to 90 hours after thermotherapy, and 2 other patients underwent prostatectomy 12 months after thermotherapy. Whole mount totally embedded prostates were mapped for necrosis and cancer, and the volume of each was measured by the grid method. RESULTS: Pathologic stages were T2a (n = 4), T2b (n = 4), and T3b (n = 1). The prostates from patients who underwent radical prostatectomy within 4 to 90 hours of thermotherapy had a mean prostate weight of 47.4 g (range 19.5 to 70.3). Each consistently showed hemorrhagic necrosis and tissue devitalization without significant inflammation. Necrosis involved contiguous areas of benign epithelium, stroma, and cancer without skip areas. The mean volume of necrosis was 8.8 cc (range 1.4 to 17.8), and the mean percentage of the prostate involved by necrosis was 22% (range 3% to 39%). The necrosis was symmetric around the urethra in 6 of 7 cases. Urethral dilation was observed in 3 patients, and the mean maximum radial distance of necrotic tissue was 1.4 cm (range 0.6 to 1.8). Necrotic change was noted in 80% to 100% of the volume of cancer in 4 cases, 40% to 60% in 2 cases, and 5% in 1 case. The prostates from the 2 patients who underwent radical prostatectomy 12 months after thermotherapy had a mean weight of 88 g (55 and 121 g, respectively). Each showed periurethral fibrosis, nonspecific chronic inflammation, and squamous metaplasia of the urothelium. The mean volume of necrosis remaining was 0.2 cc. The mean percentage of the prostate involved by necrosis 1 year after thermotherapy was less than 1%. There was some reabsorption of dead tissue. The mean maximum radial distance of the necrotic tissue was 0.4 cm (0.2 and 0.7 cm, respectively). The prostatic urethra had viable and partially denuded urothelium in all cases. CONCLUSIONS: Microwave thermotherapy is clinically useful for ablation of benign prostate and cancer contiguous to the urethra, resulting in hemorrhagic necrosis with minimal damage to the urethra. There was no apparent differential morphologic sensitivity of benign prostatic tissue, hyperplastic tissue, or cancer to thermotherapy.

No induction of beta-oxidation in leaves of Arabidopsis that over-produce lauric acid.

Leaves from transgenic Brassica napus L. plants engineered to produce lauric acid show increased levels of enzyme activities of the pathways associated with fatty acid catabolism (V.A. Eccleston and J.B. Ohlrogge, 1998, Plant Cell 10: 613-621). In order to determine if the increases in enzyme activity are mirrored by increases in the expression of genes encoding enzymes of beta-oxidation, which is the major pathway of fatty acid catabolism in plants, the medium-chain acyl-acyl carrier protein (ACP) thioesterase MCTE from California bay (Umbellularia california) was over-expressed under the control of the cauliflower mosaic virus 35S promoter in Arabidopsis thaliana (L.) Heynh. Arabidopsis was the most suitable choice for these studies since gene expression could be analyzed in a large number of independent MCTE-expressing lines using already well-characterized beta-oxidation genes. Levels of MCTE transcripts in leaves varied widely over the population of plants analyzed. Furthermore, active MCTE was produced as determined by enzymatic analysis of leaf extracts of MCTE-expressing plants. These plants incorporated laurate into triacylglycerol of seeds, but not into lipids of leaves as shown by gaschromatographic analysis of total fatty acid extracts. The expression levels of the beta-oxidation and other genes that are highly expressed during developmental stages involving rapid fatty acid degradation were measured. No significant difference in gene expression was observed among MCTE-expressing plants and transgenic and non-transgenic controls. To eliminate the possibility that post-translational mechanisms are responsible for the observed increases in enzyme activity acyl-CoA oxidase activity was also measured in leaves of MCTE-expressing plants using medium and long chain acyl-CoA substrates. No significant increases in either medium- or long-chain acyl-CoA oxidase activities were detected. We conclude that endogenous beta-oxidation is sufficient to account for the complete degradation of laurate produced in rosette leaves of Arabidopsis expressing MCTE.

Salvage brachytherapy for localized prostate cancer after radiotherapy failure.

OBJECTIVES: To evaluate the effectiveness and morbidity of salvage brachytherapy for locally recurrent or persistent prostate cancer after radiotherapy failure. METHODS: In this retrospective study, 49 patients of median age 73.3 years (range 52.9 to 86.9) with biopsy-proven localized prostate cancer underwent interactive transperineal fluoroscopic-guided and biplane ultrasound-guided brachytherapy with either iodine 125 or palladium 103 after prior radiotherapy failure. Post-treatment follow-up was conducted for a median of 64.1 months (range 26.6 to 96.8) and included clinical assessment of disease status, assays of serum prostate-specific antigen (PSA) levels, and documentation of treatment-related symptoms and complications. Determination of biochemical treatment failure was based on two successive rising PSA values above the post-treatment PSA nadir value. RESULTS: The actuarial rate of local prostate cancer control was 98% (95% confidence interval [CI] 94% to 99%). Actuarial disease-specific survival at 3 and 5 years was 89% (95% CI 73% to 96%) and 79% (95% CI 58% to 91%), respectively. At 3 and 5 years, actuarial biochemical disease-free survival was 48% (95% CI 32% to 63%) and 34% (95% CI 17% to 51%), respectively. Post-treatment PSA nadir was found to be a significant predictor of biochemical disease-free survival. Actuarial biochemical disease-free survival of patients who achieved a PSA nadir less than 0.5 ng/mL was 77% (95% CI 53% to 90%) and 56% (95% CI 25% to 78%) at 3 and 5 years, respectively. Of 49 patients, 23 (47%) achieved a post-treatment PSA nadir less than 0.5 ng/mL. The incidence of serious complications after salvage brachytherapy, such as incontinence and rectal complications, was lower than that reported after other types of salvage procedures. CONCLUSIONS: Interactive transperineal fluoroscopic-guided and biplane ultrasound-guided brachytherapy is a novel, potentially curative salvage modality for patients in whom prior radiotherapy failed. In a population of patients with poor prognosis, this modality was associated with a high rate of local prostate cancer control and a 34% actuarial rate of biochemical disease-free survival at 5 years. The incidence of major complications after salvage brachytherapy appears to be lower than that after other potentially curative salvage procedures, such as radical prostatectomy and cryoablation. Salvage brachytherapy warrants further investigation.

Transurethral microwave thermotherapy: what role should it play versus medical management in the treatment of benign prostatic hyperplasia?

Both transurethral microwave thermotherapy (TUMT) and medical management by alpha-blockade or 5-alpha-reductase inhibition are increasingly being considered as alternatives to surgery for treatment of patients with benign prostatic hyperplasia (BPH). We review current evidence supporting the effectiveness and safety of TUMT and medical management. Factors for consideration in appropriately selecting patients for TUMT versus medical management are suggested. Available data indicate that TUMT confers greater long-term benefits than medical management as judged by symptom score and peak urinary flow rate improvements. TUMT-associated morbidity is comparatively low. Alpha-blockade affords more rapid relief than TUMT for patients with BPH; however, other strategies such as the use of temporary intraurethral endoprostheses during the acute post-TUMT recovery period may diminish or abolish the differences in time-course of symptom and flow rate improvement between TUMT and alpha-blockade. 5-Alpha-reductase inhibition with finasteride offers a favorable side-effect profile, although the magnitude of symptom and flow rate improvements is modest, and maximal effects of finasteride do not become manifest until after several months of treatment. As TUMT continues to evolve, increasing attention is being accorded the delivery of high thermal doses and precise targeting of the thermal energy delivered. The development of alpha-blockers with a more favorable side-effect profile continues to be a major focus of investigation. The potential clinical utility of combination therapy with TUMT and alpha-blockade is currently under investigation.

Actuarial disease-free survival after prostate cancer brachytherapy using interactive techniques with biplane ultrasound and fluoroscopic guidance.

PURPOSE: To evaluate the effectiveness and safety of interactive transperineal brachytherapy under biplane ultrasound and fluoroscopic guidance in patients with localized prostate cancer. METHODS AND MATERIALS: Brachytherapy using 125I or 103Pd radioactive seeds either alone or in combination with adjunctive external beam radiotherapy (XRT) was administered to 490 patients at a single institution. Post-treatment follow-up included clinical assessment of disease status, assays of serum prostate-specific antigen (PSA) levels and documentation of treatment-related symptoms and complications. RESULTS: Actuarial disease-free survival at 5 yr was 79% (95% CI, 71-85%), and the 5-yr actuarial rate of local control was 98% (95% CI, 94-99%). Post-treatment PSA nadir and pretreatment PSA level were found to be significant predictors of disease-free survival. In patients with a PSA nadir < 0.5 ng/ml, 5-yr disease-free survival was 93% (95% CI, 84-97%), compared with 25% (95% CI, 5-53%) in patients whose PSA nadir was 0.5-1.0 ng/ml and 15% (95% CI, 3-38) in patients with a PSA nadir > 1.0 ng/ml. Brachytherapy was well tolerated with few post-treatment complications. CONCLUSION: A broad range of patients with localized prostate cancer can benefit from transperineal brachytherapy with minimal morbidity. A post-treatment PSA nadir below 0.5 ng/ml provides a useful prognostic indicator of favorable long-term outcome.

Interstitial cystitis in men.

OBJECTIVES: To determine the personal characteristics, the mode of presentation, the duration of the delay in diagnosis, the number of misdiagnoses, the means to achieve diagnosis, and previous treatment provided for a group of men with interstitial cystitis (IC). METHODS: A chart review of 29 men diagnosed with IC at our facility from 1988 to 1996 was performed. Basic demographic data, historical information, laboratory findings, and endoscopic and biopsy results were tabulated. RESULTS: IC in this series of men was diagnosed at a mean age of 67.3 years. There was approximately a 4-year diagnostic lag between presentation and diagnosis. The most common prior erroneous diagnoses were prostatitis in 48% and benign prostatic hypertrophy (BPH) in 38% of the men. Ulcers were encountered cystoscopically in about 70% and biopsy specimens uniformly showed nonspecific chronic cystitis at the time of diagnosis. CONCLUSIONS: IC should be considered in the differential diagnosis of voiding disorders accompanied by irritative symptoms and pelvic pain in older men. The diagnosis should be especially considered in men who are refractory to the usual treatments for BPH and prostatitis. Cystoscopy and bladder distention under anesthesia provided the most useful objective information in our hands. Biopsy is useful to rule out inflammatory cancer but adds little to the diagnosis of IC.

Contrasting heating patterns and efficiency of the Prostatron and Targis microwave antennae for thermal treatment of benign prostatic hyperplasia.

OBJECTIVES: To determine the design and performance characteristics of two microwave antennae for use in thermal treatment of benign prostatic hyperplasia. METHODS: Prostatron and Targis antennae were subjected to detailed physical examination and measurement. The heating patterns generated by these two types of antennae were characterized in detail using tissue-equivalent phantoms. Measurements of return loss as a function of frequency were conducted to evaluate the capacity of the antennae for impedance matching. Percent reflected power was calculated from the return loss results to provide a relative measure of potential for efficient delivery of thermal energy. RESULTS: The Prostatron antenna was found to be a monopole design consisting of a coaxial cable with a 3.3-cm length of inner conductor exposed at the tip. The Targis antenna was observed to be a dipole design with a 2.8-cm helical coil attached through a ground connection and a tap point to a coaxial cable. The heating pattern of the Targis antenna was symmetric; that of the Prostatron was asymmetric with substantial back heating along the catheter axis in the direction of the microwave power source. The mean extension of the 30 degrees C isotherm in the direction of the power source with the Prostatron antenna (71.5 mm; 95% confidence interval [CI], 63.4 to 79.6 mm) was 55% greater (P < 0.0005) than that with the Targis antenna (46.0 mm; 95% CI, 38.2 to 53.8 mm). Return loss with the Targis antenna declined sharply to a relative minimum value of -32.9 dB (95% CI, -73.8 to 8.0 dB) at 915 MHz, providing evidence of this antenna's capacity for impedance matching; little change was observed with the Prostatron in return loss over a frequency range 100 MHz above and below this antenna's standard operating frequency of 1296 MHz. The mean reflected power of the Targis antenna (0.4%; 95% CI, 0.0% to 1.4%) was lower by more than 20-fold (P = 0.036) than that of the Prostatron antenna (11.0%; 95% CI, 3.4% to 18.7%); thus, the potential for efficient operation was greater with the Targis than the Prostatron antenna. CONCLUSIONS: The Targis microwave antenna was found to provide a more targeted heating pattern and have a capacity for more efficient thermal energy delivery than the Prostatron antenna. These differences observed in vitro could potentially translate into clinical advantages in vivo, such as improved tolerability of microwave treatment, reduced risk of complications, greater thermoablative efficacy, and scalability.

A high-efficiency microwave thermoablation system for the treatment of benign prostatic hyperplasia: results of a randomized, sham-controlled, prospective, double-blind, multicenter clinical trial.

OBJECTIVES: To determine the effectiveness, safety, and impact on patient quality of life (QOL) of a novel transurethral microwave thermoablation system for the treatment of benign prostatic hyperplasia (BPH). METHODS: A total of 169 patients with BPH were randomized to undergo a 1-hour microwave (n = 125) or sham (n = 44) procedure using the Urologix Targis thermoablation system on an outpatient basis, without general or regional anesthesia. Symptoms, flow rates, and QOL scores were determined before the study procedure and periodically thereafter up to 6 months. RESULTS: Mean American Urological Association (AUA) score in the microwave group diminished 50% (P <0.0005) by the 6-month evaluation (10.5, 95% confidence interval [CI] 9.2 to 11.8) compared with baseline values (20.8, 95% CI 19.8 to 21.9). The sham group also exhibited lower postprocedural AUA scores; however, the magnitude of the postprocedural decline in AUA score in the microwave group was significantly greater (P <0.01) than that in the sham group. Half the microwave group had an AUA score of less than 9 by 6 months, and the decrease in symptoms was similar among patients with initially moderate versus initially severe symptoms. Mean peak urinary flow rate (Qmax) in the microwave group increased 51% (P <0.0005) by 6 months to 11.8 mL/s (95% CI 10.7 to 13.0) versus a pretreatment value of 7.8 mL/s (95% CI 7.4 to 8.2). The magnitude of the postprocedural increase in Qmax was significantly greater in the microwave than the sham group (P <0.05). In nearly half the microwave group (47%), Qmax increased 50% or more by 6 months compared with 24% of the sham group. Microwave treatment resulted in a significantly greater (P <0.05) positive impact on patient QOL than did the sham procedure. By 6 months, the QOL score in microwave-treated patients (2.2, 95% CI 1.9 to 2.4) averaged 48% lower (P <0.0005) than that at baseline (4.2, 95% CI 4.0 to 4.4). Significantly greater durability of treatment effects was also evident with microwave than with sham treatment, as judged by the higher proportion of microwave-treated patients (98.4%) requiring no further treatment during the 6-month study period versus 83.3% of sham control patients (P <0.0005). Microwave treatment was well tolerated, and complications were generally minor, readily manageable, and transitory. CONCLUSIONS: The microwave thermoablation system proved to be an effective and safe treatment modality for BPH, with a positive impact on patient QOL.