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A transurethral TEMPRO bipolar radio frequency (RF) for the treatment of chronic abacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS)

Abstract by Hong Woo Rhee, MD., Jun Sik Shin, MD.,

Hong Woo Rhee, MD., Jun Sik Shin, MD.

Introduction and Objectives:
Chronic abacterial prostatitis/chronic pelvic pain syndrome (NIH category IIIa,b) has been a challenging issue in outpatient urological practice. Although there are several kinds of medical and 2nd line therapies including thermal therapy, patients with CP/CPPS do not satisfy to eradicate or minimize the symptoms, especially pain domain.We evaluate a new bipolar RF thermal therapy to treat CP/CPPS and report our results of 431 patients after at least 3 months follow-up.

Materials and Methods:
We used the Tempro bipolar RF system with a treatment protocol of 55o C for 50 min. to 71 CP/CPPS patients (high temperature group), and then 360 patients were treated under the condition of 45oC for 60 min. without cooling (low temperature group). All the patients undergoing bipolar RF therapy were initially treated with 1st line classic regimen-ciprofloxacin, alpha blocker, NSAID- for more than 2 weeks and did not respond to improve CPSI score, especially pain domain. We evaluated the symptom improvement according to RF treatment protocol by NIH-CPSI score.

Results:
Table 1. Baseline characteristics of CP/CPPS patients

  High temp. group Low temp. group
No. of pts. (n) 71 360
Age (yrs) 42.5 ± 11.4 39.1 ± 9.6
Prostate vol.(gm) 28.4 ± 8.3. 29.6 ± 7.3
NIH category (n)    
IIIa 41(57.7%) 221(61.4%)
IIIb 30(42.3%) 139(38.6%)
Most bothersome Sx.(n)    
pelvic pain(perineal, testicular, penis tip, pubic or bladder) 49(69.0%) 259(71.9%)
urination assoc. pain 16(22.5%) 78(21.6%)
ejaculation assoc. pain 6(8.5%) 23(6.4%)



Table 2. Side effects of bipolar RF therapy on CP/CPPS according to RF protocol

  High temp. group Low temp. group p-value
Urine retention (%) 21 (29.6%) 9 (2.5%) 0.019*
Gross hematuria (%) 16 (22.5%) 31 (8.6%) 0.067
Frequency/Urgency (%) 18 (25.4%) 68 (18.9%) 0.325
UTI/Epididymitis (%) 2 (2.8%) 9 (2.5%) -

*: significant difference (P<0.05) Table 3. Results of bipolar RF efficacy on the CPSI score

  Pre-RF CPSI score Post-RF CPSI score p-value
  High temp. group Low temp. group High temp. group Low temp. group  
Total CPSI 24.1 ± 7.6 26.4 ± 6.9 16.2 ± 5.1 16.7 ± 4.8 0.074
Pain domain 12.1 ± 4.9 13.2 ± 5.1 6.3 ± 3.2 6.1 ± 4.1 0.041*
Urinationdomain 5.6 ± 3.2 6.1 ± 3.7 5.2 ± 2.7 5.7 ± 2.6 0.793
QoL domain 6.7 ± 2.3 6.9 ± 2.5 4.5 ± 1.9 4.3 ± 1.8 0.146 -

*: significant difference (P<0.05) Table 4. Overall Success rate of bipolar RF therapy on CP/CPPS

  High temp. group Low temp. group p-value
Total CPSI score 45.1% (32/71) 47.5% (171/360) 0.724
Pain domain score 63.4% (45/71) 66.9% (241/360) 0.575

 

Overall clinical success: more than 50% reduction in CPSI score at 3 months after Tempro bipolar RF therapy.

Conclusion:
The Tempro bipolar RF therapy to CP/CPPS seems to be simple and effective, especially reduction of CP/CPSS-associated pain. A low temperature protocol of RF is as effective as high temperature RF and has the minimal side effects. Additional long term follow-up and large clinical trials are required to evaluate the therapeutic potential of bipolar RF therapy for CP/CPPS.

 

  • location: Zaii Urology Hospital, Seoul, Korea

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