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					A transurethral TEMPRO bipolar radio frequency (RF) for the treatment of


  chronic abacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS)




                     Hong Woo Rhee, MD., Jun Sik Shin, MD.,
                     Jin Hong Kim, MD., Jae Sang Byun, MD.


                      Zaii Urology Hospital, Seoul, Korea




Introduction and Objectives
Chronic abacterial prostatitis/chronic pelvic pain syndrome (NIH category IIIa,b) has been
challenging issue in outpatient urologic 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 55 o 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,     49(69.0%)               259(71.9%)
      pubic or bladder)

    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*

Urination                 5.6 ± 3.2           6.1 ± 3.7        5.2 ± 2.7           5.7 ± 2.6                 0.793

domain

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.

				
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posted:12/29/2011
language:English
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