We report a novel form cell death, different from both coagulation necrosis and apoptosis. This cell death takes place after microwave coagulation therapy (MCT). MCT treated tissues preserves their shape, nuclei, and arrangement for more than 3 month. Rat liver was treated with microwave, and sacrificed as long as 2 weeks. We also examined clinical samples of MCT treated metastatic liver cancers. They were examined immuno histochemically and enzyme histochemically, and similar morphological changes took place in both rat and human. This kind of cell death caused by microwave is really unique. Microwave is widely used in the histochemical fields for antigen retrieval and fixation. The characteristics of this cell death resembles fixation. Knowledge of this form of cell death and enzyme histochemistry is essential to determine its effectiveness.
Purpose : Microwave coagulation therapy (MCT) has been performed as treatment of non-resectable hepatocellular carcinoma. We assessed the expression of heat shock protein (HSP) 70 having anti-tumor effects on hepatic MCT. Methods : The livers of adult white rabbits were irradiated using microwave tissue coagulator. The specimens were extracted at a distance 1.5 (point A) and 3.0 cm (point B) from the center of the coagulated tissue : before, 10, 30, 60, 90, and 120 minutes after irradiation. The detection of HSP70 was performed using indirect immunofluorescence analysis. Results : The expression of HSP70 was detected point A found from 10 minutes after irradiation. The expression of HSP70, however, was not detected at point B during observation period. Conclusion : The expression of HSP70 in hepatic microwave tissue coagulation possibly contributed to enhancement of anti-tumor effect.
Hysterectomy is an effective treatment for refractory menorrhagia resistant to conservative methods and the commonest major gynecologic operation. However, hysterectomy is associated with substantial post-operative morbidity. As an alternative to hysterectomy, it has become possible to destroy the endometrium in situ with minimal access techniques. Unfortunately, hysteroscopic ablation techniques require considerable surgical skill and long learning curve. Second generation ablative devices have been developed for an effective, safe, quick and easy treatment of mennorrhagia. Microwave endometrial ablation (MEA) at a frequency of 9.2 GHz was first described in 1995 and its effectiveness has been confirmed in randomized trials. Recently a new curved microwave applicator was developed for MEA at 2.45 GHz for uteri with an enlarged distorted uterine cavity. Using the applicator, menorrhagia caused by submucosal myoma nodes was successfully treated. A large number of hysterectomies could be avoided by MEA.
Menorrhagia is a disabling condition for which many women seek medical help. It is preferable to use medical instead of surgical treatment, especially if the woman desires to retain her childbearing potential or will be undergoing natural menopause within a short time. The management options after failed medical therapy have tended to be surgical. Hysterectomy is the definitive treatment, however, it is a major operation with all the attendant morbidity and mortality. Endometrial ablation means destruction of the endometrium performed by various techniques, which is a less invasive alternative to hysterectomy. Microwave endometrial ablation is one of the most promising ablative techniques developed in the past 10 years. With microwave endometrial ablation using a curved applicator to treat excessive menstrual blood loss in an enlarged uterus with a distorted uterine cavity, the incidence of hysterectomy should decrease.
Conventional ablative techniques are not indicated for an enlarged uterus of more than 12 cm in cavum length with a distorted cavity. It is difficult to perform satisfactory ablation of the endometrium in a large uterus with submucosal myomas using straight instruments. For two patients of menorrhagia due to submucosal myomas with more than 12 cm cavum length, microwave endometrial ablation (MEA) was performed using a curved microwave applicator specifically developed for uterus with an enlarged uterine cavity. Before, one, three, and six months after MEA, MRI study was performed. Menorrhagia was improved in each case. No complication was encountered. Microwave coagulation areas were clearly visualized on the Gd contrast-enhanced T1-augumented MR images. It is concluded that MEA in uteri enlarged with submucosal myomas is easily performed by employing the new curved applicator and Gd contrast-enhanced MRI is useful for depiction of a coagulated area by microwaves.
Respiratory movement disturbed MR temperature monitoring during microwave thermocoagulation of liver tumors, because MR temperature map was highly susceptible to motion. To obtain reliable MR temperature maps, it was required to suspend artificial ventilation during general anesthesia. Microwave ablations ware usually repeated many times in one procedure. Therefore, it was difficult to apply MR temperature monitoring to all of the ablations. We have developed new respiratory triggering technique for temperature monitoring utilizing the information of air way pressure, which was monitored for the control of general anesthesia. Since the ventilation was completely periodical and reproducible, respiratory triggering successfully obtained artifact-free temperature maps without suspending ventilation. This technique made it easy to apply MR temperature monitoring to the repeated microwave ablations and increased the safety of this procedure.
In the recent decades, various types of medical applications of microwaves have widely been investigated and reported. The authors have been studying the coaxial-slot antenna for microwave coagulation therapy (MCT). The shape of the heating pattern for a conventional antenna was too long and dependent on the antenna insertion depth. Therefore, to overcome this problem we have optimized the structural parameters of the coaxial-slot antenna. Moreover, we improved the input impedance of the antenna for an effective power feeding. In order to do so while keeping the improved heating pattern, we used a simple matching circuit at a position close to the feeding point of the antenna. As a result of optimization on the structure of the matching circuit, we could expand the coagulated region in the perpendicular direction of the antenna axis.
We report the clinical outcomes of 214 patients with HCC who underwent partial liver resections using MTC in accordance with the tumor sizes for patients with HCC. Seventy-three percent of the patients suffered from type C hepatitis and 45% of the patients had pathologically proven liver cirrhosis. The overall patient survival rates were 95, 79, and 65 % at 1, 3 and 5 years, respectively. Disease-free survival rates were 81, 53, and 32% at 1, 3 and 5 years, respectively. Postoperative morbidity was 28% and hospital mortality was 2.4%. Complications in most patients were well controlled although intractable bile leakage was observed in three patients. In conclusion, liver resections using MCT, in accordance with tumor sizes, can be achieved safely with acceptable results and without the need to use special techniques.
With the aim of achieving curable a radical coagulation for hepatocellular carcinoma by a single treatment, we have developed and reported a therapeutic method of percutaneous thermocoagulation under interruption of the hepatic blood flow. In the present study, the treatment outcome of thermocoagulation therapy is compared with that of hepatic resection performed in the same period, allowing a controlled evaluation of our therapeutic modality. We examined 52 cases with solitary hepatocellular carcinoma of less than 5cm in diameter which had not been treated before. The first-line therapy for these patients was percurtaneous thermocoagulation under interruption of the hepatic blood flow, and when it was difficult to carry our the thermocoagulation therapy involving a wide margin of non-cancerous tissues around the tumor, e.g., a lesion not depictable by echography, a superficial lesion of the liver and a lesion adjacent to the large vessel were chosen for hepatic resection. The hepatic blood flow was interrupted by an intravenous balloon at the outlet of the liver, then blockage of the portal blood flow was ensured by CTAP (computerized tomography aortoportography), and the hepatic artery was embolized. Thermocoagulation was achieved by percutaneous insertion of a microwave- or radiofrequency-emitter, making it a rule to cause coagulation at a time. The treated patients consisted of group A ; 26cases who recieved percutaneous thermocoagulation therapy under interruption of the hepatic blood flow (microwave n=21 ; radiofrequency n=5), and group B ; 26 cases who underwent hepatic resection. The mean tumor diameters in group A and B were 24.0±8.1mm and 33.7±10.1mm, respectively. The mean postoperative hospitalization periods for gruoup A and B were 11±3 days and 22±9 days, respectively, showing a statistically significant difference between these two groups (p<0.01). No local recurrence was observed in either group. One case of biliary fistula that needed postoperative treatment was encountered in each groups, while there was no postoperative death in either group. In 25 cases of group A and 24 cases of group B excluding deaths by other causes, the 2- and 4-year survival rates without recurrence were 49% and 49% for group A, and 55% and 33% for group B, respectively, and the 2- and 4-year cumulative survival rates were 90% and 90% for group A, and 90% and 70% for group B, respectively. In 18 cases of group A (28±6mm) and 17 cases of group B(33±6mm) having tumors ranging in diameter from 20 to 40mm, the 2- and 4-year survival rates without recurrence were 38% and 38% for group A, and 50% and 32% for group B, respectively, and the 2- and 4-year cumulative survival rates were 87% and 87% for group A, and 87% and 52% for group B, respectively, indicating no statistically significant difference between these two groups. In the choice of therapeutic modality for solitary hepatocellular carcinoma, localization of the hepatocellular carcinoma played a significant role. Our study showed that the treatment by percutaneous thermocoagulation under interruption of the hepatic blood flow provided a long-term result comparable to that of hepatic resection, and the former method was considered as an established, less invasive therapeutic modality having an advantage of a shorter hospitalization period.
25 patients with solitary HCC were firstly treated by laparoscopic microwave coagulation (LMC), 14 were firstly treated by percutaneous microwave coagulation (PMC), and 39 were initially treated by percutaneous ethanol injection (PEI). For these 78 cases, we analyzed the survival rates and compared the rates among LMC, PMC, and PEI group. 5-year survival rates were 52% in LMC group, 46% in PMC group, and 58% in PEI group. The differences of survival rates were not statistically significant among LMC, PMC, and PEI group. Next, we analyzed survival rates between microwave coagulation (MC) and PEI. When HCC were 20mm or less, 5-year survival rates (45%) in MC group were almost the same percentage as in those (65%) of PEI group (p=0.48). However, when HCC were larger than 20mm, 5-year survival rates (80%) of MC group were significantly higher than those (40%) of PEI group (p=0.011).
Therapeutic outcomes for small sized HCC were compared between ablation (Group A : n=76, 118 nodules) and limited resection (Group R : n=23, 28nodules). Mean diameters of tumors were 26.2±10.8mm in Group A and 28.0±8.9mm in Group R. Although liver function represented by ICGR15 in Group A (25.3±11.9%) was significantly poorer than that in Group R (18.6±7.0%), three-year disease free survival rate in Group A (53.5%) was similar to that in Group R (56.8%). There was no significant difference of three-year cumurative survival rate between Group A (74%) and Group R (75%). This result suggested that ablation has a potential role for local control effect equivalently to limited resection for small sized HCC.
The liver function of the most patients with HCC was impaired, because of complicated chronic hepatitis or liver cirrhosis. We evaluated the therapeutic outcomes by comparison between MCT and hepatectomy for HCC. The subjects were 94 patients with HCC undergoing MCT (n=48) or hepatectomy (n=46) from 1997 to 2003. The hepatic functional reserve was significantly worse in the MCT group than those in the Heaptectomy group. Operative bleeding and the levels of inflammatory markers were significantly lower in the MCT group. The rate of survival was not significantly. MCT for the patients of HCC with impaired liver functions is safe, less invasive, and more reliable local treatment. We suggest that therapeutic modality should be selected carefully for the patients with HCC.
In our department, indication of laparoscopic treatment for hepatocellular carcinoma (HCC) was that the long diameter of HCC was 4 cm or less, the number of HCC was 3 or less, the clinical stage was Child-Pugh A or B, and the vascular invasion was absent. The peculiar feature of laparoscopic treatment is that the objects of treatment and both HCCs on the liver surface and HCCs located deep in the liver using laparoscopic ultrasonography (LUS). The puncture methods of the tumor located deep in the liver were guide needle and immersion method using normal saline solution into the abdominal cavity. Recently convex-type LUS was developed in order to puncture the tumor located deep in the liver. From February 1998, until September 2002, 263 tumors of 197 cases underwent laparoscopic treatment. The mean long diameter of tumors was 24.0 (12-60) mm. One hundred and ninety tumors of 141 cases underwent laparoscopic radiofrequency ablation (LRA) and 73 tumors of 56 cases underwent laparoscopic microwave coagulation (LMC). Local recurrence rate was 6.1% and the recurrence rate of the other lesion was 27.4%. The survival rate was 86% in three year, and 71% in four year.
Six patients with unresectable hepatocellular carcinoma were received percutaneous microwave coagulation therapy (PMCT) during interruption of hepatic artery. After the tumor was detected by angiogram and angio-CT, patients received one to several times of PMCT with 60W and 60 seconds under intravenous anesthesia or epidural anesthesia. In only one patient, abdominal bleeding and right hemothorax were observed though she was conservatively recovered. There were no serious complications in laboratory data. We had complete tumor necrosis, and complete response in all 6 cases. The serum level of alfa-fetoprotein was normalized in 4 patients, and reduced markedly in other patients. PMCT was very useful for unresectable hepatocellular carcinoma.
Percutaneous microwave coagulation therapy (PMCT) is an effective treatment for small hepatocellular carcinoma (HCC) even in the patients with low hepatic functional reserve. Due to intervention of lung, regular PMCT using ultrasonography is anatomically rather difficult to small HCC at the dome of the liver (segment VII or VIII). In the present study, thoracoscopic MCT (TMCT) was performed on the three cases with HCC, which occured at the dome of the liver. The case 1 was a 60-year-old man showing liver cirrhosis (LC) with HCC (1cm) at S8. The case 2 was a 71-year old man having LC with recurrent HCCs at S4/8 (1.7cm) and S6 (1.5cm) after lateral segmentectomy. The cases 3 was 51-year-old man with recurrent HCC at S8 (1.4cm) after posterior segmentectomy. The cases 1 was treated by TMCT. The cases 2 and 3 were treated by TMCT with supportive small thoracotomy. All the patients showed efficient coagulation effect. No complication was observed. We concluded that thoracoscopic MCT is an effective method.
Laparoscopic microwave coagulonecrotic therapy (LMCT) for hepatocellular carcinoma is applicable for the patient whose liver damage is Child B or better. The indication is limited to the tumor smaller than 4 cm in diameter and located just beneath the surface. Hand-assistance helps to approach the tumor adjacent to the diaphragm. The hand-manipulation of the liver presents the view of the upper side of the liver to the scope. Puncturing with the electrode and scanning with ultrasound is more precise and easier than that without hand-assistance. We recommend the use of hand-assistance for laparoscopic microwave ablation to the tumor under the dome. The four cases treated by LMCT are presented, including the recurrent cases after the other treatment such as percutaneous ablation therapy and/or trans-arterial embolization.
Ablation therapies are frequently performed for small hepatocelluar carcinoma (HCC). These modalities are not indicated when the tumor is located on the surface of the liver, because there is a possibility of peritoneal dissemination of the tumor cells. We think that for these cases a laparoscopic hepatectomy is an ideal choice. This technique can be utilized in cases with severe liver chirrosis, because the laparoscopic approach is less invasive. In the present paper, we describe the important technical points of laparoscopic hepatectomy for HCC with severe cirrhosis. Indication should be limited to nodules less than 3 cm and which are located in the anterior-inferior parts of the liver. Care should be taken not to injure collateral veins in the abdominal wall. The liver parenchyma is coaluglated by microwave before dissection to reduce bleeding. For liver dissection, an ultrasonic dissector is used and larger vessels are clipped before dissection.
We have reported that the percutaneous low output microwave coagulation therapy (PLMCT) as a minimal invasive therapy was useful for the treatment for small hepatocellular carcinoma (HCC). But this time, peritoneal dissemination as the complications after PLMCT for HCC was experienced. As there is no effective systemic chemotherapy to HCC at all, these rare complications after PMCT must be avoided. We should be aware of possible peritoneal dissemination after PLMCT for HCC. Every effort should be made to prevent this serious complication, particulary in cases of superficial and less differentiated HCCs.
We underwent the open surgery in 5 patients and laparoscopic surgery (retroperitoneal approach) in 3 patients using a microwave tissue coagulator. There were no cases that shifted to the open surgery from laparoscopic surgery. However, laparoscopic approach to the renal tumor in the upper pole of the kidney should be careful for radical resection, because of the difficulty of the approach. Retroperitoneal approach should also be more careful for the ventilation of the air in the retroperitoneal cavity not to be too hot. A flexible tip of the microwave coagulator was easy to be damaged by the sheath of the trocer in a small retroperitoneal space.
Purpose : We evaluated retroperitoneoscopic patial nephrectomy for small renal tumors using microwave tissue coagulator. Materials and Methods : From June 1999 to October 2001, 10 patients with small renal tumors of less than 5.0 cm in diameter (1.0-5.0cm, T1N0M0) underwent retroperitoneoscopic patial nephrectomy without renal pedicle clamping. Result : All ten patients successfully underwent the procedure retroperitoneoscopically. Operative time was 180-405 minutes (median 275 minutes) and blood loss was 0-280mL (median 150mL). Postoperative hospitalization was 8-57 days (median 10.5 day). As a complication, one patient experienced a decrease in renal function and one patient showed severe urine leakage. Conclusions : Retroperitoneal partial nephrectomy using a microwave tissue coagulator is less invasive method and useful, but only protruding tumors should be treated with this method.
Between 1996 and 2003, ten patients with small renal tumors underwent retroperitoneoscopic partial nephrectomy without renal ischemia, nine patients with small renal tumors underwent open partial nephrectomy via a retroperitoneal approach. Both groups were operated on using a microwave tissue coagulator. We compared the results of retroperitoneoscopic group with those of a retroperitoneal open surgery group. Retroperitoneoscopic partial nephrectomy without renal ischemia was performed without any major or minor complications in any patient. The mean operation time for retroperitoneoscopic surgery significantly longer than that for open partial nephrectomy. However, the mean estimated blood loss for retroperitoneoscopic surgery was less than that for open partial nephrectomy. In addition, the retroperitoneoscopic group seemed to recover more rapidly than the open surgery group. This endoscopic surgery is feasible as minimally invasive procedure. It results in saving renal function, minimal blood loss and rapid recovery.
Recently, there have been various reports on the favorable outcomes of nephron-sparing surgery for small renal cell carcinoma, presenting its safe and reliable procedure based on the clinicopathological investigation. Between August 1993 and April 2003, partial nephrectomy for small renal cell carcinoma using microwave tissue coagulator (Microtaze® ; abbreviated as MTC) was performed in 97 patients (100 renal units) at Nara Medical University and its affiliated hospitals. In most cases except 3 patients treated with secondary nephrectomy, postoperative clinical courses were uneventful. The mean levels of serum creatinine prior to operation and that at the last examination over one month posterior to the operation were 0.87±0.19 and 1.01±0.31 mg/dL, respectively, with no significant deterioration of renal function. MRI performed at one month after the operation showed some marginal ischemic area, about 10 mm in width, around tumor-resected site, there-after with time, the ischemic area had gradually shrinked or disappered. Histopathological study revealed that MTC yielded minimum and limited necrotic change caused by heat damage around the demarcation area of coagulation. The 5-year overall-survival rate was 94% without local recurrence up to 48.8±30.3 months of the mean follow-up. Our data shows that partial nephrectomy using MTC constitutes a simple, reliable and less invasive nephron-sparing surgery for the treatment of small renal cell carcinoma.
Purpose : we performed laparoscopic partial nephrectomy in 8 cases. We will report the operative technique and the results. Methods : After retroperitoneal cavity was expanded by balloon, which was replaced by a Hasson type trocar of 12 mm and two or three trocars were inserted. The tumor was separated and the coagulation line was set 5 to 8 mm apart from the tumor margin. The renal capsule was marked using an electric scalpel use at intervals of 5-8 mm. A needle electrode was inserted, and coagulation was done at 60-80 watt for 30-40 seconds and detachment for 10-15 seconds. Results : The mean operation time was 170 minutes. The mean blood loss during operation was 71 mL. There was no major complication associated with laparoscopic procedure.
We performed enucleation on 2 patients with incidentally-found renal cell carcinoma using a microwave tissue coagulator. The mean size of the renal tumor was 25 mm. The clinical stage was T1aN0M0 in both patients. In one patient, the renal tumor was enucleated without clumping of renal artery. In the other patient, 5 minutes of clumping of renal artery was required. The mean operative time and blood loss were 113 minutes and 260 mL respectively. Enucleation of renal tumor without clumping of renal artery is possible for a microwave tissue coagulator, it could decreased operation time and blood loss, and was considered to be safe and useful.
We have performed partial nephrectomy using a microwave tissue coagulator for renal tumor. From July 1992 to March 2003, 9 patients (9 renal units) were operated and evaluated. They were 7 men and 2 women aged 46-77 years. One patient was indicated as chronic renal failure and others were elected indications. Tumors were 1.7-3.0 cm in diameter. In 8 cases, renal vessels did not clamped. It seemed that bleeding was less when coagulation output was not too high. Postoperative complications occurred as urinary leakage in one patient with the tumor in the renal hilum. Another patient was diagnosed as local recurrence several months after partial nephrectomy, and radical nephrectomy was carried out. It is considered that this method for small tumors is useful and less invasive.
We performed partial nephrectomy using a microwave tissue coagulator for 6 patients with small renal tumor. All of 6 patients were successfully treated, although intraoperative and postoperative bleeding was seen in one patient, respectively. Blood transfusion was needed in no patient. In two patients renal calyx was noticed to be opened, and closed immediately. Partial nephrectomy using microwave tissue coagulator has been considered to be safe and effective treatment procedure for small renal tumor.
The conventional method of partial nephrectomy with renal vascular clamping has a risk of excessive blood loss and renal function deterioration. Recently, a microwave tissue coagulator is often used at partial nephrectomy. It is thought that the microwave tissue coagulator can easily control the bleeding from renal parenchyma, thus renal vascular clamping is dispensable and renal function is less deteriorated. We performed 13 cases of partial nephrectomy using the microwave tissue coagulator at Yokohama city university between 1994 and 2000. Although renal vessels were clamped in many cases for a few minutes, renal function had not been worsened in all cases. We performed partial nephrectomy with less blood loss and with no significant renal function deterioration by using the microwave tissue coagulator.
We performed retroperitoneoscopic, partial nephrectomy using microwave coagulation without renal pedicle clamping. The method is minimally invasive and safe option for treating small renal tumors. To prevent complications, patients should be carefully selected by imaging examinations such as three-dimensional CT before surgery.
Radio frequency ablation (RFA) has been recently applied as an option of minimally invasive treatment of renal cell carcinoma (RCC). However, indication of this modality remains critical issue because of its lack of complete tumor destruction and its uncertainty of long terms efficacy for patient who might be a candidate for standard surgical treatment. We report the efficacy and limitation of RFA for heavily selected 6 cases of clinically localized RCC which were contraindicated for surgical treatment under general anesthesia.
We performed partial nephrectomy using a microwave tissue coagulator in 4 cases of renal cell carcinoma less than 20 millimeters in diameter. All cases were asymptomatic and the tumor was found incidentally. Tumors were resected using the microwave tissue coagulator at the power of 65W, 30 seconds for coagulation, followed by 15-25 seconds of dissociation. Mean blood loss was 73.3 mL (range : 10-140 mL), and mean operation time was 140 minutes (range : 131-157 min.). The indication in our hospital for partial nephrectomy using the microwave tissue coagulator is solitary tumors of less than 30 millimeters in diameter. We demonstrate the advantages of the non-ischemic procedure especially in intraoperative blood loss and operative time compared with five cases of conventional partial nephrectomy.
Purpose : The long-term results were studied in patients who underwent transcatheter arterial embolization (TAE) for the spontaneous rupture of renal angiomyolipoma (AML). Materal and Methods : Five cases (1 male, 4 females) who underwent TAE for spontaneous AML rupture between November 1996 and February 2000 were studied. Spontaneous rupture of AML was diagnosed with CT. Result : In 4 cases, after performing TAE only one time, the tumor size was reduced and there has been no re-rupture or re-bleeding during the ongoing follow-up. In the other case, an enucleation operation was carried out 11 days after TAE in accordance with the patient's request. Discussion : Recently, there have been a few reports on the long-term effectiveness of TAE, a conservative treatment for renal AML rupture. Our study indicated that TAE might be recommended for patients with renal AML rupture not only for stanching and pre-operative treatment but also for a conservative treatment with regular follow-up.
We report a case of the loss of the kidney function by the severe renal pelvic stricture after retroperitoneoscopic partial nephrectomy using Microwave Tissue Coagulator (MTC). Left renal tumor in a diameter of 2.5 cm was incidentally found in a 74-year-old man. Under the retroperitoneoscopy, normal kidney tissue 5 mm apart from the tumor was coagulated by MTC without renal pedicle clamping. The renal tumor was excised along the coagulated surrounding normal tissue. Convalescence was uneventful. Follow up CT and retrograde pyelography 4 months after the operation, however, showed severe stricture of the left renal pelvis, and the left renal function had been severely lost without any subjective symptoms. Renal pelvic stricture is a major complication of the laparoscopic partial nephrectomy using MTC.
We evaluated the subjective and objective treatment results of transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia and explored the difference between 30 minutes and 60 minutes single treatment retrospectively. Between June 1997 and March 2003, 58 men with BPH underwent TUMT using the TargisTM device. Twenty-seven and 31 patients received 60 and 30 minutes single treatment respectively. Evaluations after treatment included a clinical determination of the international prostate symptom score, urodynamic assessments by peak flow rate and magnetic resonance imaging (MRI). In 60 minutes treatment, the symptom score significantly improved from 17.9 to 9.5 after 2 months. Similarly, there was a significant improvement in peak flow rate, from 6.7 to 11.2 mL/sec after 2 months. In 30 minutes treatment, the symptom score significantly improved from 18.4 to 13.4 after 2 weeks. Similarly, there was a significant improvement in peak flow rate, from 6.4 to 11.7 mL/sec after 1 month. MRI imaging showed a necrosis of the prostatic gland 2 weeks after treatment in all patients. These results demonstrated that both 60 and 30 minutes treatments were effective for patients with BPH. No severe complications were seen in both groups. Moreover 30 minutes treatments led sooner improvement rather than 60 minutes ones. Thirty minutes TUMT was considered to be recommendable therapeutic time in this treatment.
Sixteen patients with bladder diverticula received transurethral microwave coagulation therapy (TUMCT) under endoscopic monitoring. The diameter of the total of 24 diverticula ranged from 1 to 11 cm (mean 2.8 cm). Fifteen patients with severe dysuria caused by prostate cancer also received TUMCT under intra-operative real-time ultrasonic scanning. Following TUMCT, 15 (63%) of 24 diverticula completely disappeared and seven (29%) of the residual 9 diverticula were reduced to less than half their previous size in diameter. All patients with prostate cancer were able to void satisfactorily without significant complications. Our clinical results indicate that TUMCT is a safe and effective treatment for bladder diverticula and a useful procedure to relieve obstructive symptoms caused by prostate cancer.