Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia: An Updated Cochrane Review

Abstract

Purpose To assess the effects of transurethral microwave thermotherapy (TUMT) for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH). Materials and Methods We performed a comprehensive search using multiple databases up to May 2021, with no language or publication status restrictions. We included parallel-group randomized controlled trials of participants with BPH who underwent TUMT. We used standard Cochrane methods, including a GRADE assessment of the certainty of the evidence (CoE). Results In this update of a previous Cochrane review, we included 16 trials with 1,919 participants. TUMT probably results in little to no difference in urologic symptom scores at short-term follow-up compared to transurethral resection of the prostate (TURP). There is likely to be little to no difference in the quality of life. TUMT likely results in fewer major adverse events. TUMT, however, probably results in a large increase in the need for retreatment. There may be little to no difference in erectile function between these interventions. However, TUMT may result in fewer cases of ejaculatory dysfunction compared to TURP. The overall CoE was moderate to low. Conclusions TUMT provides a similar reduction in urinary symptoms compared to TURP, with fewer major adverse events and fewer cases of ejaculatory dysfunction at short-term follow-up. However, TUMT probably results in a large increase in retreatment rates. Study limitations and imprecision reduced the confidence we can place in these results.

Minimally Invasive Treatment in Benign Prostatic Hyperplasia (BPH)

“…13,32 Despite the lack of long-term data, both techniques were found to be effective and safe. 40,66 HIFU, which uses radiofrequency waves to induce thermal ablation of the treated tissue, needs further investigation. Under ultrasound (US-HIFU) or magnetic resonance imaging (MR-HIFU) guidance, the correct insertion of the treatment needle into the tissue can be monitored.…”

Recent Updates in Surgical Treatment of Benign Prostatic Hyperplasia: A Review Article

“…However, TUMT probably results in a large increase in retreatment rates. 34 Similarly, in a study done for treatment of BPH by Zietek RJ et al, they inferred TUMT to be a significant choice, particularly fitting for patients who assume better urinary symptoms not including waning erectile function. 36 Water Vapor Thermal Therapy (WVTT): Convective radiofrequency water vapor thermal therapy is a new technology that uses targeted, manipulated water vapor energy (steam) to produce necrotic tissue in the prostate.…”

“…TUMT is done under an outpatient setting in local anesthesia. 34 Though it used to be a widely done minimally invasive surgical therapy, its use has waned over the last decade. 35 Franco JV et al concluded in their study that TUMT delivers a comparable decline in urinary symptoms to the TURP, with fewer unfavourable events and a small number of cases with ejaculatory dysfunction shortly.…”

Quick prioritization of Cochrane reviews on benign conditions of the prostate

“…External stakeholders highlighted the need for reviews on minimally invasive treatments and desmopressin for lower urinary tract symptoms, for which there is a suite of Cochrane reviews [20,[22][23][24][25][26]. The CRG strategy for dissemination was co-publication of those reviews [22,[27][28][29], which has been shown to improve the impact of Cochrane reviews by reaching a highly specialized readership [30]. Moreover, both reviews have been cited in clinical practice guidelines.…”