Prostatic Microwave Ablation

Background and introduction of Benign prostatic hyperplasia

Benign Prostatic Hyperplasia (BPH) is a condition which causes an enlargement of the prostate gland that is non-cancerous. This enlargement is mainly associated with aging in men. The prostate is a small gland located beneath the bladder, surrounding the urethra. It works as a male reproductive organ. It undergoes such hormonal changes as men grow older; with age this gland grows. This prostatic enlargement compresses the urethra that causes obstructive urinary symptoms and disturb the quality of life.

The Incidence of BPH

BPH is one of the most insidious age-related urological conditions worldwide. Its incidence usually increases with age: 50% of the young males in their 50s have it, about 60% of the older generations in their 60s suffer from it, and up to 90% of those more than 80 years old will present symptoms of BPH. Since BPH is not fatal, it exhibits various symptoms, which, taken together, are categorized as lower urinary tract symptoms (LUTS), that can disrupt daily activities. Common symptoms are nocturia (getting up at night to urinate frequently), the initiation or maintenance of urination being difficult, weak urine flow with the subjective feeling of incomplete bladder emptying. BPH can also cause obstructive urinary retention, repeated urinary tract infections, stones in the bladder, and in very severe cases, even damage to the kidneys.

Considering that BPH is a condition that occurs in the population so frequently and has the potential to cause several different symptoms , effective treatment remains imperative to enhancing the outcome for patients and reducing any risk of further complications.

Traditional forms of surgery for BPH

It has been conventional, for several decades, for BPH surgery states to involve surgery. The most common procedure is Transurethral Resection of the Prostate (TURP), in which all excess prostate tissue is removed via the urethra using a resectoscope. Though effective in alleviating urinary issues for patients and improving quality of life, it has major disadvantages, as follows:

1. Risk of Complications: Risks are as follows: bleeding; infection; hypo ejaculations; and rarely, erectile dysfunction.
2. More Time Required for Recovery: Such patients need a stay in the hospital and longer catheterization and weeks to recover fully after the TURP.
3. Invasiveness: This procedure may not be amenable to old-aged patients or patients with comorbidities as it has higher risks with a general anesthesia setting.

In extreme cases of BPH, open prostatectomy surgery (partial or complete surgical removal of the prostate) is the remedy. This is again more invasive, usually needs a greater period of stay in the hospital, and greatly increases the risk of complications.

Emergence of Minimally Invasive Procedures

With the advancement of medical technologies and the rise in the demand for safer and less invasive, but effective procedures, minimally invasive procedures (MIPs) were introduced for the treatment of BPH. The concept behind these techniques is to offer symptom relief and reduction in the size of the prostate comparable to what is possible through conventional surgery but with lower risks and faster recovery times.

1. Prostate Artery Embolization (PAE)

PAE is a state-of-the-art, image-guided, minimally invasive procedure offering by interventional radiologists. Simply said, in PAE, a catheter is inserted, through a tiny puncture in the groin or wrist, into the arteries that supply the prostate and tiny particles known as embolic agents are injected to block blood flow to the prostate. The gland will shrink over time leading to less urinary symptoms as a result of that.

Here are some advantages of PAE:

• Day Care Procedure: Most of the patients go home on the same day.
• Lower Risk of Complications: PAE has a lesser risk of bleeding and infections and causes lesser sexual dysfunction as compared with TURP.
• Fast Recovery: It could return to its normal routine within a few days.
• Preservation of Sexual Function: PAE has even less effect on erectile function and ejaculation.

PAE is a good option for patients wanting to avoid surgery or patients with comorbidities when traditional surgery can be risky.

2. Ablative Procedures

They use energy-based technologies to remove or destroy excess prostate tissue. Such as:

• Laser Therapies: Techniques of latter types such as Holmium Laser Enucleation of Prostate (HoLEP) or GreenLight Laser Vaporization are popularly known to limit damage to surrounding structures but aim precisely on the prostate tissue. Laser therapies are useful to treat large prostates with much less risk bleeding.
• Microwave or Radiofrequency Ablation: Microwave or radiofrequency waves generate heat using this method, which will shrink prostate tissue. It is considered fast and safe and is a good option for a patient looking for less invasive treatment.

Advantages of Ablative Procedures:

• Reduced likelihood of bleeding for well-directed targeting.
• A Shorter stay in the hospital, as well as a rapid recovery time.
• Suitable for those patients taking anticoagulants or those having other medical conditions.

Why Minimally Invasive Procedures Are Replacing Surgery.

Techniques like very tiny invasive PAE and ablative therapy are fast-changing status regarding their management in benign prostatic hyperplasia because they relieve symptoms that are effective with fewer possible risks. Some of the reasons behind their growing popularity include:

• Reduced Risk Profile: Such procedures have minimized complications like bleeding, infection, and sexual dysfunction that make the procedures safer in older and high-risk patients.
• Faster Recovery: these minimally invasive procedures allow normal activities to resume within days as compared to weeks for conventional surgery.
• Outpatient: Most minimally invasive treatments are performed on an outpatient basis, therefore reducing hospital stays and healthcare costs.
• Preservation of Quality of Life: These methodologies are minimally invasive and as such have a lower cost on sexual health, which is an important consideration for many patients.

Prostate Transperineal Percutaneous Ablation Using Microwave at IRFacilities

At IRFacilities, a leading center for interventional radiology (IR) and neurointerventional radiology (NIR) in the region, we offer state-of-the-art prostate transperineal percutaneous microwave ablation—a minimally invasive and highly effective procedure for prostate treatment. Here’s an overview of this advanced technique:

Benefits of Transperineal Microwave Ablation:

1. Minimally Invasive: This procedure does not require arterial access, reducing risks and improving patient comfort.
2. Outpatient Procedure: Most patients can be discharged within 4–6 hours after the procedure.
3. Elderly-Friendly: It uses anesthesia that minimally impacts the physiology of older patients, ensuring safety and comfort.
4. Effective Results: This cutting-edge treatment is emerging as one of the best options for minimally invasive prostate care.

Pre-Procedural Assessment

1. Comprehensive Counseling: Patients are thoroughly counseled on the procedure’s benefits and what to expect, ensuring they are informed and comfortable.
2. Diagnostic Tests and Imaging: During the first OPD visit, patients undergo:
• Routine blood tests, including PSA (Prostate-Specific Antigen).
• Urodynamics and uroflowmetry to assess urinary function.
• Transperineal and transrectal ultrasound for detailed prostate imaging.
3. No CT or CT Angiography Required: Unlike other procedures, CT imaging is unnecessary when planning transperineal microwave ablation, streamlining the pre-procedural process.
4. Report Analysis and Scheduling: After these investigations, patients experience minimal discomfort, as the procedure involves only a few needle pricks. They are sent home while the IR team carefully analyzes the results. Once the reports and imaging are reviewed, the patient is scheduled for the ablation.

Prostate Transperineal Percutaneous Ablation Using Microwave:

Actual Procedure Details at IRFacilities At IRFacilities, we perform prostate transperineal microwave ablation with precision and patient comfort as a priority. Here is a detailed description of the procedure:

Pre-Procedure Preparations

1. Pre-Surgical Instructions:
• The patient is advised to fast overnight and report to the hospital by 8 a.m. on the procedure day.
• A 0.5 mg dose of is prescribed the night before to ensure calmness.
• Patients continue their regular medications for conditions like hypertension or diabetes.
2. Hospital Arrival and Initial Setup:
• Upon arrival, an IV line is secured, and vitals are closely monitored.
• A daycare anesthesiologist assesses the patient before proceeding to the operating table.
3. Equipment Preparation:
• A high-end ultrasound machine with uninterrupted power supply and a microwave Ablation machine are prepared and checked for functionality.
4. Draping and Anesthesia:
• The perineal area is cleaned, draped, and painted with antiseptic solution.
• The patient is positioned in a lithotomy position, and ultrasound-guided local or caudal anesthesia is administered for comfort.

Procedure Steps

1. Microwave Probe Insertion:
• Using perineal ultrasound guidance, a microwave probe is inserted into the prostate.
• Two serial zones (medial and lateral) in each half of the prostate are ablated serially using a protocol of 20 watts for 2 minutes per focus(usually 3) pertract.
2. Ablation Process:
• The probe is withdrawn by 1 cm after each ablation to ensure comprehensive coverage of the prostate tissue.
• White "fumes" observed on the ultrasound confirm successful tissue ablation.
3. Quality Check with Truss Probe:
• A transrectal ultrasound using a trus probe ensures the ablated areas are accurately targeted.
• If needed, additional ablation is performed to address any deficiencies.
4. Safety Measures:
• Midline structures such as the urethra are carefully avoided.
• The use of a cooling-tip microwave probe prevents burns to the perineal skin or other unintended areas.
5. Post-Procedure Completion:
• The probes are removed, and small adhesive bandages are applied.
• The entire procedure is completed in 15-20 minutes, with minimal discomfort to the patient.

Post-Procedure Care

• The patient is mobilized within an hour and does not require mandatory bed rest.
• Hemodynamic stability and potential complications such as bleeding are closely monitored.

• Patients are discharged within 4-6 hours with antibiotics and mild painkillers.
• Minimal post-procedure pain is reported, and patients can resume normal activities quickly.

Why Choose IRFacilities?

Our expert team ensures that prostate microwave ablation is performed efficiently, safely, and with the highest level of patient satisfaction. With advanced equipment and experienced operators, IRFacilities is the trusted choice for minimally invasive prostate treatments.