The aim of the therapy is to reduce the volume of the prostate so that voiding problems are alleviated.
The procedure takes between 10-15 minutes (when using the preferred Schelin catheter, pending approval by FDA for use in US) and is performed by sending microwaves into the prostate using a specially designed catheter. A temperature sensor is also inserted via the catheter to record the internal temperature in the prostate tissue. Microwaves heat the problem areas of the prostate tissue and destroy these areas. As the treating physician you follow the whole process on a computer screen and adjust the microwave power accordingly.
What examinations must be carried out prior to CoreTherm® therapy?
Therapy with CoreTherm® should be preceded by an examination carried out by a urologist. The examination should confirm that BPH is the cause of the patient’s symptoms. The examination includes an IPPS questionnaire, measurement of urine flow, ultrasound examination of the prostate and rectal palpation of the prostate. Urethrocystoscopy may also be required.
Pre-treatment preparation
- The area to be treated should be cleaned.
- The patient should empty his bladder and the remaining fluid should be drained via a catheter.
- The penis and urethra are anaesthetised and lubricated using a transurethral gel. The patient can also be given a painkiller and/or a sedative.
- The intraprostatic anaesthetic can beneficially be administered using a Schelin catheter (only EU, pending approval by FDA for US).
- When the anaesthetic has begun to take effect the treating physician should insert the treatment catheter via the urethra. To hold the catheter in place it is fitted with a small balloon/cuff. This should be filled with sterile water. Insert the intraprostatic temperature sensor via the catheter.
- Finally insert the rectal probe in the rectum and fasten the penis temperature sensor around the base of the penis, this measures the skin temperature external to the penile urethra.
Is a general anaesthetic or spinal anaesthesia given during the therapy?
No. CoreTherm® is carried out under local anaesthetic. Preferably a Schelin catheter is used to administer intraprostatic anaesthetic and adrenaline. Not applicable in US, pending FDA´s approval. In this way there is no, or only minimal, blood flow in the prostate during therapy. If required the patient may be given analgesia and a tranquilizing agent. The patient remains conscious during the entire procedure and you can monitor the patient’s condition throughout.
Will the patient experience discomfort or pain during the procedure?
Most patients do not perceive the procedure to be painful. It is however usual for patients to feel some discomfort and sensations of urinary urgency. How much discomfort the patient experiences differs from patient to patient and it is therefore important that you talk to your patient during the entire procedure.
Aftercare
Following the procedure the cells of the urinary tract and prostate gland become swollen. It takes some time for the swelling to go down and the patient therefore needs to have an indwelling catheter for 2 to 3 weeks. To reduce the risk of infection you can prescribe a suitable antibiotic.
Can the patient go home directly after the therapy?
Yes. The treatment itself takes about 10-15 minutes and you can normally discharge the patient after a few hours. Depending on use of anaesthesia method.
Will the patient feel discomfort after the procedure?
Some patients don’t feel any discomfort after therapy, while others experience urinary urgency. This is due to the prostate becoming irritated and swollen, but this will gradually disappear. Some patients feel urinary urgency to be a problem, especially during the first few days after therapy. The problem becomes less as the swelling goes down and then disappears completely.
Does the patient need a catheter after the procedure?
Yes. Following therapy your patient will need an indwelling catheter for a while. You as the patient’s physician must determine for how long, but 2-4 weeks are recommended depending on which catheter is used and the general health of the patient.
Does the patient need medication following therapy?
It is not unusual to prescribe an antibiotic following therapy to avoid urinary tract infections whilst the patient has an indwelling catheter. For a few days after the procedure some patients need analgesia. Discuss such needs with the patient. In the long-term no medication is needed following CoreTherm® therapy.