Transurethral high-intensity ultrasound for treatment of stress urinary incontinence (SUI): simulation studies with patient-specific models

作     者：Liu, Dong Adams, Matthew S. Burdette, E. C. Diederich, Chris J. 

作者机构：Univ Calif San Francisco Dept Radiat Oncol San Francisco CA 94143 USA Acoust MedSyst Inc Savoy IL USA 

出 版 物：《INTERNATIONAL JOURNAL OF HYPERTHERMIA》 (国际高温杂志)

年 卷 期：2018年第34卷第8期

页      面：1236-1247页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 1009[医学-特种医学] 10[医学] 

基　　金：NIH [R44DK108458  R44CA121740] 

主　　题：Thermal therapy high-intensity ultrasound stress urinary incontinence therapeutic ultrasound thermal ablation 

摘      要：Background: Stress urinary incontinence (SUI) is prevalent in adult women, attributed to weakened endopelvic supporting tissues, and typically treated using drugs and invasive surgical procedures. The objective of this in silico study is to explore transurethral high-intensity ultrasound for delivery of precise thermal therapy to the endopelvic tissues adjacent to the mid-urethra, to induce thermal remodeling as a potential minimally invasive treatment ***: 3D acoustic (Rayleigh-Sommerfeld) and biothermal (Pennes bioheat) models of the ultrasound applicator and surrounding tissues were devised. Parametric studies over transducer configuration [frequency, radius-of-curvature (ROC)] and treatment settings (power, duration) were performed, and select cases on patient-specific models were used for further evaluation. Transient temperature and thermal dose distributions were calculated, and temperature and dose metrics ***: Configurations using a 5-MHz curvilinear transducer (3.5x10mm, 28mm ROC) with single 90s sonication can create heated zones with 11mm penetration (50 degrees C) while sparing the inner 1.8mm (45 degrees C) radial depth of the urethral mucosa. Sequential and discrete applicator rotations can sweep out bilateral coagulation volumes (1.4W power, 15 degrees rotations, 600s total time), produce large volumetric (1124mm(3) above 60 EM43 degrees C) and wide angular (approximate to 50.5 degrees per lateral sweep) coverage, with up to 15.6mm thermal penetration and at least 1.6mm radial urethral protection (5EM(43 degrees C)).Conclusion: Transurethral applicators with curvilinear ultrasound transducers can deliver spatially selective temperature elevations to lateral mid-urethral targets as a possible means to tighten the endopelvic fascia and adjacent tissues.