Transurethral ethanol ablation of prostate safely relieves BPH symptoms
Monday, 29 November 1999 19:00 | 
| Radiology News - Radiology Articles |
Symptomatic benign prostatic hyperplasia (BPH) that's unresponsive to drug therapy can be treated successfully by transurethral ethanol ablation of the prostate (TEAP).
Symptomatic benign prostatic hyperplasia (BPH) that's unresponsive to drug therapy can be treated successfully by transurethral ethanol ablation of the prostate (TEAP), according to a report in the March issue of The Journal of Urology.
Previous international trials of TEAP have indicated that the procedure is potentially efficacious and relatively safe, the authors explain.
To begin the process of getting the procedure approved by the US Food and Drug Administration, Dr. Mark K. Plante from the University of Vermont College of Medicine, Burlington, and colleagues evaluated the safety and potential efficacy of TEAP in a dose-ranging phase I/II trial involving 79 men with drug-refractory voiding symptoms related to BPH.
"Ethanol was injected transurethrally into the prostate with a curved cystoscopic needle in men randomly assigned to 1 of 3 doses: 15 per cent, 25 per cent or 40 per cent of prostate volume by transrectal ultrasound," the team reports. Procedures lasted a mean of 25 minutes.
Most patients (98 per cent) were able to void when the Foley catheter was removed 3 days or more after the procedure.
The most common adverse events included hematuria (41.8 per cent), irritative voiding symptoms (39.2 per cent), pain/discomfort (27.8 per cent), urinary retention (21.5 per cent), and urinary incontinence (13.9 per cent), but these complaints typically resolved within the first 4 weeks after the procedure.
Cystoscopic examination 1 month after TEAP showed no evidence of bladder wall necrosis, the researchers found.
After TEAP, there were significant improvements in overall symptoms, maximum flow rate, post-void residual volume, and prostate volume, the report indicates. Improvements were seen by the first postoperative month in most patients, improvements increased at 3 months and were sustained to 6 months.
The clinical improvements were independent of treatment dose and prostate size, the investigators note.
"TEAP is a promising minimally invasive treatment option for symptomatic BPH," the authors conclude. "The early results of the trial support its potential efficacy in men with symptomatic BPH."
"The widespread application of TEAP may provide a less expensive, but still safe and effective treatment option for poorer third world countries, and should not be ignored by the Western academic urological community," writes Dr. J. Curtis Nickel from Queen's University, Kingston, Ontario, Canada in a related editorial comment. "This and other trials evaluating TEAP strongly suggest that prospective randomized sham or positive comparator (i.e., to TURP) trials should be undertaken."
J Urol 2007;177:1030-1035
Previous international trials of TEAP have indicated that the procedure is potentially efficacious and relatively safe, the authors explain.
To begin the process of getting the procedure approved by the US Food and Drug Administration, Dr. Mark K. Plante from the University of Vermont College of Medicine, Burlington, and colleagues evaluated the safety and potential efficacy of TEAP in a dose-ranging phase I/II trial involving 79 men with drug-refractory voiding symptoms related to BPH.
"Ethanol was injected transurethrally into the prostate with a curved cystoscopic needle in men randomly assigned to 1 of 3 doses: 15 per cent, 25 per cent or 40 per cent of prostate volume by transrectal ultrasound," the team reports. Procedures lasted a mean of 25 minutes.
Most patients (98 per cent) were able to void when the Foley catheter was removed 3 days or more after the procedure.
The most common adverse events included hematuria (41.8 per cent), irritative voiding symptoms (39.2 per cent), pain/discomfort (27.8 per cent), urinary retention (21.5 per cent), and urinary incontinence (13.9 per cent), but these complaints typically resolved within the first 4 weeks after the procedure.
Cystoscopic examination 1 month after TEAP showed no evidence of bladder wall necrosis, the researchers found.
After TEAP, there were significant improvements in overall symptoms, maximum flow rate, post-void residual volume, and prostate volume, the report indicates. Improvements were seen by the first postoperative month in most patients, improvements increased at 3 months and were sustained to 6 months.
The clinical improvements were independent of treatment dose and prostate size, the investigators note.
"TEAP is a promising minimally invasive treatment option for symptomatic BPH," the authors conclude. "The early results of the trial support its potential efficacy in men with symptomatic BPH."
"The widespread application of TEAP may provide a less expensive, but still safe and effective treatment option for poorer third world countries, and should not be ignored by the Western academic urological community," writes Dr. J. Curtis Nickel from Queen's University, Kingston, Ontario, Canada in a related editorial comment. "This and other trials evaluating TEAP strongly suggest that prospective randomized sham or positive comparator (i.e., to TURP) trials should be undertaken."
J Urol 2007;177:1030-1035
