Indications
TUMT is an alternative to drug therapy or more invasive surgery for BPH treatment. This treatment might be right for you if any of the following apply:
- You do not want to take another daily pill
- You have tried BPH medication but are unhappy with the side effects
- You do not want to undergo major surgery with a higher risk of side effects and complications
- You want to regain your quality of life with minimal downtime
Testing
You made need the following tests prior to TUMT:
- Cystoscopy
- Uroflow
- Prostate Ultrasound
- Urodynamics (Less common)
- Urinalysis
Procedure
TUMT is often done with local anesthesia (urethral and prostatic) along with the use of oral drugs to relax you (Valium) and pain medication. Once in the procedure room and after verifying the absence of a urinary tract infection urethral lidocaine will be placed along with an optional prostatic block performed under transrectal ultrasound. This block is done through a rectal ultrasound probe.
The doctor then inserts a special catheter through your urethra into your prostate area. Proper positioning is confirmed by ultrasound followed by placement of a rectal balloon catheter to measure temperature. During the procedure microwave energy from the electrode destroys the inner portion of the enlarged prostate gland, but not enough energy to damage surrounding tissues. Circulating water through the catheter protects the urethra and the rectal temperature sensors ensure that the energy to the rectum is below a safe degree of heating.
The energy destroys the prostate tissue which is responsible for blocking your urine flow and over a period of weeks to months the prostatic tissue “shrinks” improving urination.
During the procedure you may feel urgency to urinate and some bladder spasms. The level of discomfort may adjust the energy used and the length of time for treatment.
After the Procedure
The prostate and urethra will require a few days of recovery before you can urinate on your own. During this time, you may be catheterized to allow the urinary tract and prostate to heal. There will be some irritation and sensations of needing to urinate. Some blood in the urine is not uncommon and urgency with incontinence may be present for a few days after the procedure. Any procedure in which a catheter is inserted or remains in place can increase the risk of urinary tract infections.
You should notice an improvement in your urination a few weeks after the procedure. This may continue to improve for a few months as the prostate shrinks.
It will require some time for the body to reabsorb the treated prostatic tissue and will usually take approximately six to twelve weeks before BPH symptoms improve. The ultimate goal of TUMT is long-term relief of BPH symptoms with minimal side-effects.
Benefits
- Outpatient procedure without need for general anesthesia
- Can be done in patients with multiple other medical conditions
- Minimal risk of bleeding
Results
15 studies involving 1585 patients who underwent microwave thermotherapy
- Six studies compared microwave thermotherapy with TURP, and eight were comparisons with sham thermotherapy
- The pooled mean urinary symptom scores decreased by 77 percent with TURP and by 65 percent with microwave thermotherapy
- The pooled mean peak urinary flow increased by 119 percent with TURP, and by 70 percent for microwave thermotherapy
- The differences for the International Prostate Symptom Score (IPSS) and peak urinary flow were significantly greater for TURP. However, compared with TURP, microwave thermotherapy was associated with decreased rates of retrograde ejaculation, urethral stricture, hematuria, blood transfusion, and transurethral resection syndrome but increased incidence of dysuria, urinary retention, and retreatment for BPH symptoms.
Microwave thermotherapy for benign prostatic hyperplasia. AUHoffman RM, Monga M, Elliott SP, Macdonald R, Langsjoen J, Tacklind J, Wilt TJ SOCochrane Database Syst Rev. 2012
Complications
TUMT is generally safe with few if any major complications. Possible risks of TUMT might include:
- Retrograde Ejaculation (Rare)
- Mild Hematuria
- New onset or worsening urinary symptoms. Sometimes TUMT can result in chronic inflammation within the prostate. The inflammation can cause symptoms such as a frequent or urgent need to urinate, and painful urination
- Postprocedural urinary retention. You might have trouble urinating for a few days after the procedure
- Urinary tract infection. This type of infection is a possible complication after any prostate procedure. An infection is increasingly likely to occur the longer you have a catheter in place
Need for re-treatment. TUMT might be less effective on urinary symptoms than other minimally invasive treatments or surgery. You might need to be treated again with another BPH therapy
Contraindications
TUMT might not be a treatment option if you have:
- A penile implant
- Narrowing of the urethra (urethral stricture)
- Abnormal prostatic anatomy with intravesical median lobe