High‐energy transurethral microwave thermotherapy: symptomatic vs urodynamic success

Abstract

RESULTSAll patients completed at least 1 year of follow-up after TUMT as monotherapy. The symptom score improved from a median (range) of 20.5 (11-28) initially to 9 (0-28) ( P < 0.001). Twenty-two patients (55%) had a marked and 11 (28%) a moderate response, giving an overall subjective success rate of 83%. Similarly, there was a significant improvement in peak flow rate, from 9.2 (4.4-13.4) to 15 (3.3-22.9) mL/s ( P < 0.001). Twenty-one patients (53%) had a maximum flow rate of > 15 mL/s while in eight (20%) it was 10-15 mL/s. Only 20 patients changed from unobstructed on the pressure-flow nomogram, i.e. an overall objective success rate of 50%. Gadolinium-enhanced T1-weighted MRI 1 week after treatment showed a median (range) perfusion defect of 20.7 (5.5-76.6)% of the total gland volume. Despite this persisting in all patients, a welldefined cavity was apparent in only in seven (18%) at the final evaluation. Cystoscopy 1 month after therapy showed evidence of necrotic tissue occupying the prostatic fossa in all patients. Younger patients were more likely to be urodynamically successful, and a higher grade of obstruction predicted symptomatic success. CONCLUSIONHigh-energy TUMT can induce considerable necrosis of the prostate, as shown by MRI and cystoscopy. Although there was an adequate improvement in most patients' symptoms, there was a successful urodynamic change to unobstructed in only half the patients. Younger patients and those with a higher grade of obstruction were more likely to have urodynamic and symptomatic success, respectively.

Transperineal Microwave Thermoablation in Patients with Obstructive Benign Prostatic Hyperplasia: A Phase I Clinical Study with a New Mini-Choked Microwave Applicator

“…Heat penetration in the prostate depends on the water content of the different types of tissues, and the frequencies and exposure time used for application. [24][25] Moreover, low-energy treatments seem to be inadequate to obtain satisfactory results, in terms of the ability to induce necrosis and subsequent reduction of urinary outlet obstruction. [26][27] On the other hand, high-energy treatments gave good results in terms of improvement in urinary obstruction, but are burdened with increased morbidity.…”

Urodynamics to guide surgical therapy in LUTS/BPH

“…Osman et al [18] treated men with TUMT (Targis device, high energy) and reviewed predictors of urodynamic and symptomatic success. They used PFUDs-grading obstruction based on Schäfer's nomogram-and found that higher grade obstruction rather than free-fl ow rate predicted symptomatic improvement after treatment.…”