Mediating transurethral microwave thermotherapy by intraprostatic and periprostatic injections of mepivacaine epinephrine: effects on treatment time, energy consumption, and patient comfort.

Background And Purpose: Profound intraprostatic blood flow may complicate reaching a therapeutic temperature in the prostate during transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH). A retrospective survey is presented describing the effect of intraprostatic and periprostatic administration of mepivacaine epinephrine on treatment time, intraprostatic blood flow, energy delivery, and patient comfort.

Patients And Methods: Fifteen consecutive obstructed patients with lower urinary tract symptoms attributable to BPH received TUMT (ProstaLund Feedback Treatment). In order to improve patient comfort, injections of 10 mL of 0.5% mepivacaine epinephrine were administered in three locations into the prostate prior to treatment. The results were compared with those of a reference group consisting of 35 consecutive patients who had received ProstaLund Feedback Treatment without administration of mepivacaine epinephrine.

Results: Patients who received intraprostatic mepivacaine epinephrine had a shorter treatment time (32+/-9 minutes v 61+/-6 minutes), required less energy (65+/-27 kJ v 172+/-32 kJ), and had a lower calculated intraprostatic blood flow (13+/-5 units/minute v 26+/-12 units/minute) than the reference group. Patients receiving mepivacaine epinephrine also required less analgesic medication during the treatment. The clinical outcome in terms of symptom scores and peak uroflow rates appeared to be similar for the two groups.

Conclusion: Intraprostatic injection of mepivacaine epinephrine prior to TUMT seems to have beneficial effects. It may represent an important improvement of thermotherapy and enable successful treatment of those patients who previously failed secondary to a profound intraprostatic blood flow.