How to select patients suitable for transurethral microwave thermotherapy: a systematic evaluation of potentially predictive variables

Abstract

Objective To identify clinical variables useful in predicting outcome after transurethral microwave thermotherapy (TUMT) of the prostate with Prostasoft v. 2.0. Patients and methods Thirty‐eight men with symptomatic benign prostatic hyperplasia (BPH) were treated with TUMT using the Prostatron device with the low‐energy (v. 2.0) software. Before and 6 months after treatment symptoms were evaluated using the Madsen‐Iversen (M‐I) symptom score, a clinical examination and suprapubic pressure‐flow measurement, free urinary peak flow rate (Qmax ) and determination of post‐void residual urine volume (PVR). Bladder outlet obstruction was assessed from urodynamic pressure‐flow studies using the classification of Abrams and Griffiths, the obstruction grading of Schäfer, and calculation of other published factors, e.g. the urethral resistance, an obstruction index and the detrusor adjusted mean passive urethral resistance factor (DAMPF). Categories of M‐I score (total, irritative and obstructive), PVR and Qmax were investigated to determine whether any could predict the outcome after low‐energy TUMT. The values after treatment and changes in Qmax , M‐I score and PVR were used as efficacy variables. Results Variables describing infravesical obstruction had predictive characteristics that may be useful in selecting patients for TUMT v. 2.0 and significantly better results were obtained in patients with a low to moderate obstruction as graded using the DAMPF classification of obstruction. The results also indicated that patients with a high irritative M‐I score or a Qmax of 7–14 mL/s were those who fared best after TUMT. Conclusions Variables expressing the obstruction grade seem to be useful in predicting outcome after TUMT (v. 2.0). Patients with a high obstruction index are probably unsuitable for TUMT (v 2.0).

TUMT 2.0: Results Three Months and Three Years after Treatment

“…Damage to sensory nerves and reinnervation could explain the limited duration of symptomatic improvement seen in this study and could explain why we found no changes of Qmax or on ultrasonography, and only retrograde ejaculation in one of 13 patients. The conclusion of an extensive analysis of urodynamic parameters was that there was no useful predictive potential in the common urodynamical parameters including the Schäfer grading of obstruction used by us (9). This we have confirmed.…”

Transition Zone Index and Bothersomeness of Voiding Symptoms as Predictors of Early Unfavorable Outcomes after Transurethral Resection of Prostate

“…The impact of traditionally used subjective and objective parameters on treatment outcome has been studied [10][11][12] , but the results are not reliable. In this study, all parameters after TURP changed significantly, from 55.1 to 116%, and that determined the overall effectiveness of the treatment.…”

TURP and low‐energy TUMT treatment in men with LUTS suggestive of bladder outlet obstruction selected by means of pressure‐flow studies: 8‐year follow‐up

“…Tubaro et al [1995] evaluated the e¡ect of TUMTand strati¢ed patients according to the type of obstruction (constrictive and compressive). In studies selecting patients for TURP, one-dimensional classi¢cations of obstruction based on the Abrams^Gri⁄ths nomogram [Abrams, 1994] or the SchÌfer nomogram [SchÌfer, 1995] are usually applied [Jensen et al, 1996;Walde¤ n et al, 1998;Rodrigues et al, 2001]. In the present study, classi¢cation according to the SchÌfer nomogram and DAMPF scale was used to grade BOO in simple terms of more or less obstructed.…”

“…TURP is associated with signi¢cant morbidity, mortality, and retreatment rates even when performed by experienced urologists. Approximately 25^40% of patients claim dissatisfaction with the outcome of surgery and the results have been reported to be less favorable in patients with lower grades of obstruction [Jensen et al, 1996;Walde¤ n et al, 1998;Rodrigues et al, 2001]. The early identi¢cation of these patients, who are not expected to bene¢t from operation, becomes an important issue.…”