The Research Center of Urology, Tashkent, Uzbekistan.

Benign prostatic hyperplasia (BPH) morfologically represents as hormone-dependent tumor, rising and developing connected with growing old of the organism (1,2). Spreadness of the disease among men 60 and older years make up 60-84% (3). Management of BPH is a significant problem in medical and economical aspects. Most effective therapy for BPH is surgical transurethral resection of the prostate (TURP) (4). This method concern to invasive, and has some complications and significant contraindications. In the last years minimally invasive methods of management of BPH have great importance, and Transurethral Needle Ablation of prostate (TUNA) is one of ie most effective one (10). Radio frequency of 500 kHz, power 15-16 W, duration of effect 3-5 min were used for TUNA (6). The heating affect around the needle :-ansurethrally setted into prostate tissue will form zone of the coagulative necrosis .destruction) in the shape of oblonged spheroid. Length correspond to the length of the r.eedle, diametrical - 15-20 mm. Later this zone replace by fibrous scar (tissue), accordingly will decrease volume of the prostate and improve bladder outlet obstruction. The procedure require local anesthesia. Efficient ness remain 2 years and over time (5.9).

Contraindications for the TUNA procedure are volume of the prostate over 80 ml, presense of expressed median lobes of the prostate, strictures of the urethra, bladder stones and urinary tract infections and high anesthethic risk for operation. Moreover, existing TUNA devices made in specially for this procedure and they are enough expensive, that is problem for wide spread of the method. Thus, elaboration of more convenient approach for the radiofrequent ablation of prostate and making more rerfect and cheaper radiofrequent generator is present-day problem for treatment ratients with BPH.

MATERIALS AND METHODS

We elaborated method of transvesical needle ablation (TVNA) of prostate, which we successfuJjy used on 20 patients of age from 57 to 83 years old, (who were observing in RCU in t999-2000yy) An International-Prostate Symptom Score (I-PSS) and Bother 

Score (BS) responses were recorded. The mean Symptom Score prior to treatment were 19.17+01.3 and 4,67+00,3, accordingly. The peak uroflow (Qmax) rate was 2,77+00.7 ml/sec. the mean volume of residual urine (RU) was 354,47+047,8 ml. We volume of prostate estimated by ml. And assesed by transrectal ultrasound scan of the prostate (TRUSP). Volume of prostate in observing patients was mean 54,37+05,9 ml (range 30-110ml).

Presense of bladder outlet obstruction (BOO) confirmed by pressure flow urodinamic studies (Pdet at Qmax, cm H20) and estimated by nomogramm of Abrams-Griffits. All patients were in zone of obstruction, and mean index of Pdet at Qmax was 129,77+010.3 cm H20. By integral index state first degree of operative risk (ASA) determinated on 1 patient (5,0%), second V 12 (60,0%) and third - 7 (35,0%). Efficientness estimated by abovementioned criterions, compare obtaining dates with initial ones in time 1,3. 6 and 12 months after procedure.

TREATMENT

For the transvesical needle ablation of prostate we used have being epicistic fistula or we formed it in a moment with main intervention. The visual control of manipulation and for placing needle electrode into prostate we used standart rigid uretrocystoscope 21CH, supplying with Albarran. As a Radio Frequent (RF) generator used electrosurgycal apparatus (ESA) - ESHF-440-40-1, elaborated and manufactured by collaborators of RIU "Akadempribor". This apparatus generate radiofrequent waves 440kHz with maximum power 40W in a range of regulation from 2 to 40W with discretion 20 sec. Nominal range of resistanse of load - from 40 to 2500m. Service and functional possibilities of the generator is secure by using microprocessor for control, measuring parametrs of outlet signals and providing setted tasks of work of indication and signalisation. ESA has manual and automatic tasks of work. Processor of the apparatus maintain for memorable programms. which has possibilities for enter corresponding dates, securing task and keeping up on outlet of power generator and the time of it using from 20 sec to 10 min. After corresponding preparations, the patient is placed in lithotomy position. In a sacral area placed indifferent (neutral) electrode. By prepared approuch the urethrocystiscope bringed into bladder and after screening cystoscopy and estimation of configuration of bladder neck and lobes of prostate, we determinates the places for a injection of the electroded needles. In a time we visualized the prostate by transrectal ultrasound and periodically controlled the disposition of the needle. Into sheaths of the urethrocystiscope inserts needle electrode in a teflon cover. After needle electrode inserts into one of the lobe of prostate without a teflon cover. All the manipulations are conducting under transrectal ultrasound control. Alter insertion of electrode, beginning ablation, which carryed out by previously according programm in handle regime or automatically. As a irrigating solution we used glycine 1,5%. ower of feeding energy raised from initial 2W and complete were 16W. Raising realized every 20 sec by 1 W. In this regime process of total destruction prostate tissue complete in a 4-6 min. After finishing of coagulation needle electrode extracted and repositioned into another previously planned place and similar procedure performed for times which preoperativly planned. TVNA carryed out by local, medullary anesthesia or intravenous narcosis. When procedure is completed we left epicistic drenage.

Patients usually are able to leave within 2-3 hours after the procedure. By periodically clamping of drainage we determinated ability for micturation, and quality of micturation we estimated by flow rate recording. Controlling evaluation accomplished 1, 3. 6 and 12 mounths after procedure. RESULTS AND DISCUSSION.

Technique of TVNA is simplier (easyer) than TUNA. According to quantity and sizes of lobes of prostate ablation were made from 2 to 8 time, deepness of insertion of electrode to the lateral lobes were 20-60 mm (39.17+03,8mm) and to the median lobe were 10-45mm (28,07+03,5mm). Duration of procedure in common, including the time for making corresponding approach were 30-110 min (77,37+08,4 min), but direct ablation continued 25-70 min (42,37+04,3 min). In 2 cases simultaneously with TVNA were carryed out cistolitotripsies. Nearest and remote observing dates revealed, that TVNA made considerable clinical improvement, all patients treated tolerated the treatment well. Anyone essential complications nor during manipulation neither after noted, also not observed any lethal outcomes. In different period after TVNA the spontaneous micturation restored in 18 (90,0%) patients, which much more than in other authors -about 70% after TUNA of BPH. More than foreseeing time we should last to drain the bladder by reason of detrusor underactivity in 1 patient (5,0%). In our opinion unsuccessful result in 1 patient (5,0%) were caused in a reason of technique mistakes during the procedure. He has a good result after the TURP. The results of contol observing after TVNA prove, that 1 mounths after manipulation is a positive changes in all criteria of evaluation of LUTS and it has tendency to improvement. So, to the end of the first month the total score of I-PSS and BS reliablly reduced (p<0,01), 3 months later they were 4.87+01,5 and 1,47+00,2, reduced on 74,12 and 69,52% (p<0,001) accorddingly, and these indexes will improve for a later time. In the period noted increasing of Qave, which became 10.27+01,3 ml/sec (p<0,001) and

 

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