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

Abstract

Objective To compare the efficacy and frequency of complications of transurethral interstitial laser coagulation (ILC) and transurethral microwave thermotherapy (TUMT) with transurethral resection or incision of the prostate (TURP/TUIP) in patients with symptomatic benign prostatic hyperplasia (BPH). Patients and methods Forty-eight patients were randomized to undergo ILC, 46 to TUMT and 24 to TURP/ TUIP; they were followed for 6 months and the outcome analysed on an intention-to-treat basis. Results At 6 months the symptom scores and maximum urinary flow rate (Q max ) had improved significantly in all groups. At 6 months the mean symptom score was 9.2 in both experimental groups and 6.8 in the control group ( P > 0.05); the mean Q max was 20.6 mL/s in the control group, 16.2 in the ILC group ( P > 0.05 vs control) and 13.2 in the TUMT group ( P < 0.05 vs. the control group). In the TUMT group patients developing urinary retention afterward had a significantly greater increase in Q max than those who did not. The types of complications in the three groups varied. Urinary tract infection occurred frequently in the experimental groups, especially after ILC, whereas the 'well-known' complications of TURP occurred in the control group.Overall, 36% in the ILC, 54% in the TUMT and 73% in the control group had no complications (retrograde ejaculation excluded) during the first 6 months. One patient in the TUMT group underwent TURP after 3 months, whereas no patients in the ILC or the control group were re-treated for BPH within the first 6 months. Conclusion In the short term both ILC and TUMT are reasonable alternatives to standard transurethral surgery for symptomatic BPH, where the reduction of symptoms is the primary goal of treatment. However, both ILC and TUMT were associated with morbidity, although the complication profiles differed from those after TURP/TUIP. Both ILC and TUMT seem advantageous in some patients because of the reduced risk of bleeding and the eliminated risk of TUR syndrome, and because TUMT only requires local anaesthesia. Thus, as neither treatment is better in all aspects, the advantages of one technique over the other must be weighed when deciding how to treat each patient.

Combination of Channel-TURP and ILC versus Standard TURP or ILC for Elderly with Benign Prostatic Hyperplasia: A Randomized Prospective Trial

“…A change of 3 points in the IPSS is perceptible to patients. Assuming a Gaussian distribution of IPSS with a standard deviation (SD) of 4, choosing a minimal relevant difference of 3.2, a risk of type 1 error of 0.05 and a risk of type 2 error of 0.10, the sample size was calculated and results suggested that a minimal of 50 patients should be included in each group [20,21] . Data are expressed as mean 8 SD or number of cases (percentage).…”

“…This technique usually leads to postoperative complications including acute urinary retention and irritative voiding [24][25][26] because the heat treatment is closely related to postoperative edema which may worsen the obstructive symptoms and result in urinary retention [27] . The median time in which urinary retention resolves is about 45 days following ILC [21] . Some researchers proposed the application of temporary and biodegradable stents following ILC [28] .…”

Photoselective vaporization of the prostate. Review of cost implementation to BPH treatment

“…19,20 In the short term, minimally invasive surgical therapies such as TUMT have been shown to be less expensive and as effective or less effective than TURP. [21][22][23][24] In contrast, patients choosing a treatment pathway starting with medical therapy and ending with successful TURP or open simple prostatectomy, have the highest lifetime treatment costs. 19,25,26 The evidence supporting these results is not of high-level since only five studies address the longterm cost consequences or cost effectiveness of various BPH treatment alternatives beyond a few years period.…”

Is the minimally invasive treatment as good as transurethral resection for benign prostatic hyperplasia?

“…Six studies were evaluated involving 540 patients with a median follow-up of 6-12 months (Table 2) [6,7,[9][10][11][12]. The pooled mean urinary symptom score decreased 65% with TUMT and 77% with TURP.…”