Objective To compare pressure-flow results before and 3Results There was a significantly greater improvement in pressure-flow variables, i.e. maximum urinary flow months after transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH), perrate, detrusor pressure at maximum flow and minimal urethral opening pressure, in those treated with higher formed with lower and higher energy protocols. Patients and methods Twenty-four patients were treated energy TUMT than in those receiving the lower energy protocol. The Madsen and quality-of-life scores, and using a high-energy protocol performed with a heatshock strategy, i.e. a rapid increase in intraprostatic maximum urinary flow rate on uroflowmetry, were also significantly better in the higher energy group. temperatures to a maximum of 55-67°C. A helical antenna was used which produced maximum heating Conclusion Higher energy TUMT performed using a heat-shock strategy provides a better pressure-flow at the base of the prostate. A further 25 patients were treated using a lower energy protocol with a slow outcome than lower energy thermotherapy. Compared with previously published results, the outcome after increase in intraprostatic temperatures to a maximum of 45-53°C. A first-generation filament antenna was higher energy TUMT is at least similar to other treatment alternatives for BPH. used with the maximum heat produced at the prostatic apex. All treatments were performed as single-session Keywords Prostatic hyperplasia, microwave thermotherapy, pressure-flow, higher energy outpatient procedures of 60-70 min duration.agreement that the only reliable way to diagnose and