High-Energy Transurethral Microwave Thermotherapy in Men with Lower Urinary Tract Symptoms

Abstract

Since 1993, we have treated patients having lower urinary tract symptoms and benign prostatic obstruction using the high-energy transurethral microwave thermotherapy (HE-TUMT) protocol (Prostasoft; software version 2.5). This study was conducted to investigate the outcome and durability of this treatment. A series of 301 patients with a mean prostate size of 56.4 cc were treated by HE-TUMT if they had a Madsen Symptom Score > or = 8, a maximum flow rate < 15 mL/sec, a voided volume > or = 100 mL, and a postvoiding residual volume < 350 mL. The prostate volume measured by transrectal ultrasonography was > or = 25 cc. Follow-up visits were scheduled at 12, 52, 78, and 104 weeks. Patients were stratified according to the response evaluation criteria set at the 3rd International Consultation on Benign Prostatic Hyperplasia. These response criteria were measured at 12 weeks. At 2 years, there appeared to be a better response in the bigger prostates. Irrespective of relief of outflow obstruction, a good symptomatic response was seen in both good and poor responders. Twenty-two patients were re-treated during the 2-year follow-up period: three underwent bladder neck incision, nine transurethral resection, two laser prostatectomy, one open prostatectomy, and seven additional medical therapy. At 2-year follow-up, HE-TUMT resulted in a durable good outcome in 93% of patients with an objective improvement rate of 42% and a subjective improvement rate of 65%. The best predictor of durability appeared to be the extent of relief of obstruction. Of the 96 bad responders in this group, 14 underwent retreatment, compared with 6 of the 100 good responders.

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

“…This rate was highly influenced by whether the patient had urinary retention or not. The frequency of UTI, which includes those cases treated by the family physician, was higher than the 0-15% reported in most published series [35], although De Wildt et al [36] reported 29% with UTI and 7% with epididymitis after high-energy TUMT. As expected, the incidence of retrograde ejaculation was lower in the TUMT than in the control group, although the difference was not significant.…”

A Randomized Study Comparing High&ndash;Energy TUMT to TURP: Quality&ndash;of&ndash;Life Results

“…TUMT has been shown to be a fairly effective, single–session, anesthesia–free, outpatient treatment modality [14, 15, 16, 17]. TUMT consists of microwave energy administered transurethrally, simultaneously providing radiative heat to the prostate and conductive cooling to the urethra.…”

Transurethral microwave thermotherapy for treatment of benign prostatic hyperplasia

“…One study used nomogramms to select ideal candidates for TUMT using the Prostatron device. A prediction of good response was possible in 78% of patients using the bladder outflow obstruction (BOO) grade, in 72% using the Q max , and in 97% using the IPSS [53].…”