Transurethral Microwave Thermotherapy

Abstract

Transurethral resection of the prostate (TURP) remains the gold standard for treatment of benign prostatic hyperplasia (BPH). Although this procedure is generally safe, patients require a spinal, epidural, or general anesthesia and often need several days of hospital stay. In addition, potential morbidity limits the use of TURP in high-risk patients. Pharmacotherapy has been recommended as a first line therapy for all patients with mild-to-moderate symptoms. Unfortunately, the long-term outcomes of such therapy have not been fully elucidated. Patients must adhere to a strict medication schedule, and outcome indicators for pharmacotherapy are not reached as well or as reliably as outcome indicators for TURP. Patients choose pharmacotherapy because of the perceived reduced risk of adverse events and the desire to avoid surgery. This trade-off of risk for efficacy is a common thread running through all elective treatments for BPH. Newer modalities have been aimed at providing alternatives to pharmacotherapy or watchful waiting. Patients prefer a one-time treatment for lower urinary tract symptoms (LUTS) resulting from BPH, provided the method offers reduced risk and allows efficacy equal to that of medical therapy. One such method is transurethral microwave thermotherapy (TUMT). Heat in the form of microwaves is used for the destruction of hyperplastic prostate tissue. Early results show excellent symptomatic relief, with one outpatient encounter using minimal anesthesia. Clinical indications and treatment parameters for TUMT are still evolving as technology advances and more experience is gained. This chapter summarizes current knowledge regarding the indications and efficacy of microwave therapy of the prostate.