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Potentially Dangerous Blood Pressure Surges During Office-Based Transurethral Microwave Thermotherapy Treatments Of the Prostate
Thayne R Larson*1, Lance Mynderse*2, V. Sommers*2, Mike Jaffs*3, William Evans4, Benjamin Larson*5
1Institute of Medical Research, Scottsdale, AZ;2Mayo Clinic Rochester, Rochester, MN;3Massachusetts General Hospital, Boston, MA;4Soutwest Florida Urologic Association, Ft. Myers, FL;5aCleveland Clinic Lerner College of Medicne of Case Western Reserve University, Cleveland, OH
Introduction: Transurethral microwave therapy is mainly used in the office setting without any general anesthesia. Patients who require this procedure are of the age to have known or occult systemic atherosclerosis. Acute hypertension is the most common risk factor for atherosclerosis, and marked surges in arterial blood pressure may result in acute cardiovascular events, included myocardial infarction, stroke, aortic dissection, and even death.
Methods: We retrospectively reviewed 194 consecutive microwave cases from various institutions that routinely measure blood pressure during treatment. There are representative cases from all the FDA approved machines - Cooled ThermoCath (CTC) 12, Coretherm 17, Prolieve 60, Prostatron 61, Targis 27, Thermatrx 17. Routine local, oral, IM or IV anesthetics were used. Prostatic blocks were used in 14 %. Blood pressure increases over baseline (pre treatment) were calculated.
Results: Percent of Total Patients with Increase over Baseline:| Amount of Increase | Systolic Pressure | Diastolic Pressure | Mean Arterial
Pressure | | > 30 mmHg | 40% | 15% | 25% | | > 50 mmHg | 16% | 3% | 5% | | > 70 mmHg | 6% | 1% | 1% | | > 40 % of baseline | 17% | 17% | 15% | There is a definite variance in blood pressure rise among the machines. In systolic rise 50mmHg group the range between machines are 2% - 30% of patients. Conclusions: This study is designed only to raise the awareness of potentially dangerous elevations in arterial blood pressure during the various microwave treatments. It is critical to measure blood pressure repeatedly during the procedure and tailor the treatment and anesthesia.
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