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HKU pioneers BPH water vapour thermal therapy in Asia

Natalia Reoutova
03 Jul 2020
From left: Dr Wayne Lam, Dr James Tsu
Urologists from the LKS Faculty of Medicine at the University of Hong Kong (HKU) have introduced and successfully carried out Asia’s first water vapour thermal therapy for benign prostatic hyperplasia (BPH).

“BPH is very common and affects approximately 60 percent of Chinese men over the age of 70 years,” stated Dr James Tsu of the Division of Urology, HKU. [Sci Rep 2015;5:13546]

BPH is associated with lower urinary tract symptoms (LUTS) such as slow urine flow, frequent urination, persistent sensation of incomplete bladder emptying, frequent urination at night, recurrent urinary tract infections, and inability to pass urine in severe cases, which could lead to serious kidney injury.

While medication and lifestyle modifications, such as reducing fluid intake before bedtime, and avoiding caffeinated drinks and certain types of Chinese soups that may have a mild diuretic effect, are effective in some BPH patients, patients with larger prostates may need to undergo surgery.

Developed in the 1930s, transurethral resection of prostate (TURP) has been considered the gold standard of BPH surgical management for many decades. However, the procedure is associated with complications, such as considerable intraoperative bleeding, and the vast majority of patients develop permanent ejaculatory dysfunction after surgery. TURP lasts approximately 60 minutes, requires spinal or general anaesthesia, and is typically followed by a hospital stay of 2 to 4 days.

Compared with TURP, water vapour thermal therapy offers the advantages of minimal anaesthesia with a very short procedure time of less than 15 minutes, and the ability to discharge patients on the same day. Studies have demonstrated its efficacy in BPH treatment with a very low retreatment rate. It is also associated with minimal side effects, with the vast majority of patients being able to preserve their ejaculatory function after the procedure.

“Water vapour thermal therapy has no impact on erectile function and does not cause ejaculatory dysfunction,” stressed Dr Wayne Lam of the Division of Urology, HKU. “This is particularly valuable to men who have not yet completed their families.”

The new procedure utilizes convective water vapour energy for ablation of prostate tissue. The system’s power unit generates thermal energy by condensing radiofrequency-heated sterile water vapour. The energy generated is delivered via a fine curved needle, which punctures the prostate capsule under direct endoscopic supervision and delivers the sterile vapour into the enlarged prostate. The large amount of energy is rapidly and uniformly dispersed through the targeted prostate region. The prostate begins to shrink from the second week after the procedure, and consolidation continues over a course of several months.

“HKU is the first to introduce water vapour thermal therapy to treat BPH in Asia. The procedure was first carried out [at HKU] in January 2020 on three symptomatic BPH patients. The reduction of prostate size was between 31 percent and 49 percent within 3 months after the procedure. All three patients had a considerable improvement in urine flow and a substantial reduction in International Prostate Symptom Score [IPSS], indicative of amelioration of LUTS. All three patients had preserved ejaculatory function,” reported Lam.
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