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Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezūm(®) system: evaluation of acute ablative capabilities in the human prostate
BACKGROUND: The purpose of this study was to assess the acute ablative characteristics of transurethral convective water vapor (steam) using the Rezūm(®) system in men with benign prostatic hyperplasia through histologic and radiographic studies. METHODS: Seven patients were treated with transurethr...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321608/ https://www.ncbi.nlm.nih.gov/pubmed/25674555 http://dx.doi.org/10.2147/RRU.S74040 |
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author | Dixon, Christopher M Rijo Cedano, Edwin Mynderse, Lance A Larson, Thayne R |
author_facet | Dixon, Christopher M Rijo Cedano, Edwin Mynderse, Lance A Larson, Thayne R |
author_sort | Dixon, Christopher M |
collection | PubMed |
description | BACKGROUND: The purpose of this study was to assess the acute ablative characteristics of transurethral convective water vapor (steam) using the Rezūm(®) system in men with benign prostatic hyperplasia through histologic and radiographic studies. METHODS: Seven patients were treated with transurethral intraprostatic injections of sterile steam under endoscopic visualization followed by previously scheduled adenectomies. The extirpated adenomas were grossly examined followed by whole mount sectioning and staining with triphenyl-tetrazolium chloride (TTC) to evaluate thermal ablation. Histology was performed after hematoxylin and eosin staining on one prostate. After review of results from the first patient cohort, an additional 15 patients with clinical benign prostatic hyperplasia were treated followed by gadolinium-enhanced magnetic resonance imaging (MRI) at one week. RESULTS: In the first patient cohort, gross examination of TTC-stained tissue showed thermal ablation in the transition zone. In addition, there was a distinct interface between viable and necrotic prostatic parenchyma. Histopathologic examination revealed TTC staining-outlined necrotic versus viable tissue. Gadolinium-enhanced MRIs in the cohort of 15 patients demonstrated lesion defects in all patients at 1 week post-procedure. Coalesced lesions were noted with a mean (± standard deviation) lesion volume of 9.6±8.5 cm(3). The largest lesion volume was 35.1 cm(3). Ablation using vapor was rapid and remained confined to the transition zone, consistent with the thermodynamic principles of convective thermal energy transfer. CONCLUSION: Thermal ablation was observed in all specimens. The resulting coalescing ablative lesions, as seen on MRI, were confined to the transition zone. These studies confirm the ablative capabilities of vapor, validate the thermodynamic principles of convective heating, and allow for further clinical studies. |
format | Online Article Text |
id | pubmed-4321608 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-43216082015-02-11 Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezūm(®) system: evaluation of acute ablative capabilities in the human prostate Dixon, Christopher M Rijo Cedano, Edwin Mynderse, Lance A Larson, Thayne R Res Rep Urol Original Research BACKGROUND: The purpose of this study was to assess the acute ablative characteristics of transurethral convective water vapor (steam) using the Rezūm(®) system in men with benign prostatic hyperplasia through histologic and radiographic studies. METHODS: Seven patients were treated with transurethral intraprostatic injections of sterile steam under endoscopic visualization followed by previously scheduled adenectomies. The extirpated adenomas were grossly examined followed by whole mount sectioning and staining with triphenyl-tetrazolium chloride (TTC) to evaluate thermal ablation. Histology was performed after hematoxylin and eosin staining on one prostate. After review of results from the first patient cohort, an additional 15 patients with clinical benign prostatic hyperplasia were treated followed by gadolinium-enhanced magnetic resonance imaging (MRI) at one week. RESULTS: In the first patient cohort, gross examination of TTC-stained tissue showed thermal ablation in the transition zone. In addition, there was a distinct interface between viable and necrotic prostatic parenchyma. Histopathologic examination revealed TTC staining-outlined necrotic versus viable tissue. Gadolinium-enhanced MRIs in the cohort of 15 patients demonstrated lesion defects in all patients at 1 week post-procedure. Coalesced lesions were noted with a mean (± standard deviation) lesion volume of 9.6±8.5 cm(3). The largest lesion volume was 35.1 cm(3). Ablation using vapor was rapid and remained confined to the transition zone, consistent with the thermodynamic principles of convective thermal energy transfer. CONCLUSION: Thermal ablation was observed in all specimens. The resulting coalescing ablative lesions, as seen on MRI, were confined to the transition zone. These studies confirm the ablative capabilities of vapor, validate the thermodynamic principles of convective heating, and allow for further clinical studies. Dove Medical Press 2015-01-30 /pmc/articles/PMC4321608/ /pubmed/25674555 http://dx.doi.org/10.2147/RRU.S74040 Text en © 2015 Dixon et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Original Research Dixon, Christopher M Rijo Cedano, Edwin Mynderse, Lance A Larson, Thayne R Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezūm(®) system: evaluation of acute ablative capabilities in the human prostate |
title | Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezūm(®) system: evaluation of acute ablative capabilities in the human prostate |
title_full | Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezūm(®) system: evaluation of acute ablative capabilities in the human prostate |
title_fullStr | Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezūm(®) system: evaluation of acute ablative capabilities in the human prostate |
title_full_unstemmed | Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezūm(®) system: evaluation of acute ablative capabilities in the human prostate |
title_short | Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezūm(®) system: evaluation of acute ablative capabilities in the human prostate |
title_sort | transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the rezūm(®) system: evaluation of acute ablative capabilities in the human prostate |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321608/ https://www.ncbi.nlm.nih.gov/pubmed/25674555 http://dx.doi.org/10.2147/RRU.S74040 |
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