Transurethral Microwave Thermotherapy: An Alternative to Medical Management in Patients with Benign Prostatic Hyperplasia?

Abstract

Transurethral microwave thermotherapy (TUMT) is being increasingly considered as an alternative to medical management with alpha-blockers or finasteride in patients with lower urinary tract symptoms (LUTS) of benign prostate hyperplasia (BPH). Enduring clinical benefits have been demonstrated after a single 1-hour microwave treatment session under topical anesthesia, and the associated morbidity is low. Optimal results are obtained with the delivery of high thermal doses and accurate targeting of microwave energy. Extensive evidence from randomized clinical trials supports the safety and efficacy of both microwave treatment and medical management, but randomized trial data have only recently become available directly comparing these two approaches to BPH treatment. These data indicate that greater long-term improvements in symptoms, peak urinary flow rates, and quality of life are attained with microwave treatment than with alpha-blockade. Furthermore, the actuarial rate of treatment failure is markedly lower in patients undergoing microwave v alpha-blocker treatment. However, the onset of action of alpha-blocker treatment is more rapid. The principal limitations of alpha-blockade are side effects and lack of efficacy leading to treatment failure in some patients. The maximal effects of finasteride are modest and require a period of months to be manifested, although the side effect profile and tolerability of this agent are favorable. Neoadjuvant and adjuvant alpha-blocker therapy can accelerate symptom and flow rate improvement after TUMT. In contrast to medical management, microwave treatment is highly versatile, allowing patients over a broad range of baseline symptom severities and prostate sizes to be treated with a high probability of success.

High-Energy Microwave Thermotherapy in the Treatment of Benign Prostatic Hyperplasia

“…The limitations of ·-lytic therapy are its loss of effectiveness in 5.8% of patients and the side effects reported in 13.3-20.4% of cases. The maximum effect of finasteride is modest and it takes some months to manifest itself [22].…”

Transurethral microwave thermotherapy: first experiences in Poland

“…Many studies have confirmed the efficacy of HeTUMT in treating BPH [1–3,8–12,16–21], and when compared with a sham procedure [17,21]. The method is thought to decrease subjective complaints by 50% at 6 months after treatment, decrease the PVR by 30–69%, and increase the flow rate by 45–84% [3,8,9,11,12,16,21].…”

“…The place of HeTUMT amongst treatment methods for BPH remains to be established, but it is considered to be a serious alternative to pharmacotherapy, with a delayed but more durable effect and a lower failure rate [1,2]. He‐TUMT can be administered as an outpatient procedure, with no need for anaesthesia, and patients at high surgical risk, as assessed by the ASA scale, can be treated safely [3,4].…”