Water-Induced Thermotherapy

Dr Guercini in Rome, Italy and Dr Shoskes in Florida, US have both found WIT to be helpful in relieving symptoms.

There is an important difference between WIT for BPH and WIT used for CPPS: the BPH technique uses temperatures around 6O-62 degrees Celsius, enough to destroy tissue, whereas the CPPS technique uses temperatures between 40-47 degrees, making it a safe, non-destructive procedure. Interestingly, neither technique kills bacteria since tap water has to be heated above 65 degrees Celsius to reliably kill all bacterial enteropathogens, and 72 degrees is the FDA-recommended temperature to sterilize meat and kill E. coli. Another interesting point: using WIT, people speculate that the combination of heat and compression reduces the heat sink effect of the circulating blood, thus enhancing the thermal energy transfer to the compressed tissue.

WATER INDUCED THERMOTHERAPY (WIT) FOR THE TREATMENT OF CHRONIC PELVIC PAIN SYNDROME (CPPS) - A MULTI-CENTRE FEASIBILITY STUDY

Federico M Guercini*, Rome, Italy, Jaspal Virdi, Harlow, UK, T Kreutzig , Freiburg, , Germany, Cinzia Pajoncini, Rome, Italy, Luigi Mearini, Massimo Porena, Perugia, Italy

Introduction and Objectives:

Chronic pelvic pain syndrome (CPPS) in men is a common condition where treatment outcomes have been unsatisfactory. Since 1987, several methods of treatment utilizing thermal therapies have been investigated. Transrectal and transurethral thermal therapies, utilizing focused microwave and radiofrequency have shown disappointing results due to the irregular transmission of heat to the prostate gland.

Unlike the above mentioned treatment methods, water-induced thermotherapy (WIT) utilizes conductive heat, maintained at a constant temperature by a computerized console. The heat is transmitted to the prostate via a treatment balloon, and circulated through a proprietary closed-loop catheter system.

Methods:

A total of 30 patients, (mean age 41 years, range 24- 63) with CPPS were treated utilizing water-induced thermotherapy (ArgoMed Inc., Cary NC. USA) between February and May 2001. Study participants completed their NIH Prostatitis Symptom Score and underwent uroflowmetry at baseline, 1, 6, and 12 months following treatment. Cystoscopic measurement was utilized to determine the prostatic urethral length, measured between the bladder neck and the verumontanum, in order to select the appropriate treatment balloon size. All study participants were treated at 47ºC in a single 45-minute session, utilizing only topical anesthetic gel.

Results:

Improvements were seen in the NIH Chronic Pain Symptom Index (CPSI), pain scores, urinary symptom scores and quality of life scores (QoL). Overall, the NIH CPSI score improved by 55% at 12 months.. Similar responses were noted in pain scores, (57.6%), urinary symptom scores (45.9%) and QoL (50%). Peak flow rates and average flow rates remained constant during the follow-up period. (+/- 1 ml/sec), indicating that the treatment did not negatively affect the patients’ urine flow (see table).

The most significant predictor of change was the degree of symptom severity at baseline; with higher baseline scores reporting greater symptom improvement. Men with moderate to severe symptoms represented the majority of patients at baseline. In the three scheduled follow-up appointments, the number of patients with severe symptoms constantly decreased, the majority rating their symptoms as mild, with a few reporting moderate symptom scores (see graphs)

Conclusion:

Preliminary results indicate that water-induced thermotherapy, a minimally invasive, well-tolerated procedure, is an efficacious, durable, and viable option for the treatment of CPPS. Conductive heat provides a homogeneous uniform depth of penetration, and since no necrosis is produced at this lower treatment temperature, there is no need for post-treatment catheterization.

Criteria	BASELINE (30 patients)	1 MONTH (25 patients)	6 MONTH (17 patients)	12 MONTH (24 patients)
Pain (% Change) Score (S): 0-21	11.8 Moderate (7<S≤14)	8.9 (-24.6%) Moderate (7<S≤14)	.9 (-41.5%) Mild (0≤S≤7)	5.0 (-57.6%) Mild (0≤S≤7)
Urinary Symptoms (% Change) Score (S): 0-10	3.7 Moderate (3<S≤6)	2.7 (-27.0%) Mild (0≤S≤3)	2.9 (-21.6%) Mild (0≤S≤3)	2.0 (-45.9%) Mild 0≤S≤3)
Quality of Life (% Change) Score (S): 0-12	8.6 Severe (8<S≤12)	6.8 (-20.9%) Moderate (4<S≤8)	5.1 (-40.7%) Moderate (4<S≤8)	4.3 (-50.0%) M oderate (4<S≤8)
Peak Flow (ml/sec)	20.0	20.3	20.2	19.8
Average Flow (ml/sec)	12.3	13.3	11.0	11.1

References:

1. Servadio C., Leib Z., and Lev A. Disease of prostate treated by local microwave hyperthermia, Urology, vol. 30, pp. 97-99,1987.
2. Servadio C. and Leib Z., Chronic abacterial prostatitis and hyperthermia: A possible new treatment?, British Journal of Urology, vol. 67, pp. 308-311, 1991.
3. Montorsi F. et al., Is there a role for transrectal microwave hyperthermia of the prostate in the treatment of abacterial prostatitis and prostatodynia?, Prostate, vol. 22, pp. 139-146, 1993.
4. Choi N. G. et al, Clinical experience with transurethral microwave thermotherapy for chronic nonbacterial prostatitis and prostatodynia, Journal of Endourology, vol. 8, pp. 61-64, 1994.
5. Nickel J.C. and Sorenson R., Transurethral microwave thermotherapy of nonbacterial prostatitis and prostatodynia: initial experience, Urology, vol. 44, pp. 458-460, 1994.
6. Nickel J.C. and Sorenson R., Transurethral microwave thermotherapy for nonbacterial prostatitis: a randomized double-blind sham controlled study using new prostatitis specific assessment questionnaires, Journal of Urology, vol. 155, pp. 1950-1955, 1996.
7. Nickel J.C., Siemens D.R., and Johnston B. Transurethral radiofrequency hot balloon thermal therapy in chronic nonbacterial prostatitis, Techniques in Urology, vol. 4, pp. 128-130, 1998.

Source of Funding: NONE

Unpublished, presented as a booth presentation at the AUA Annual meeting 2002 in Orlando, FL.