TRANSURETHRAL MICROWAVE THERMOTHERAPY - P ILOT-STUDY ON THE VALUE OF THE DORNIER UROWAVE

TUMT applies high-power microwave energy deep within the lateral prost atic lobe and should lead to a decrease in adenoma volume and destruct ion of a certain specific cell type involved in outlet obstruction. Th e aim of the present study was the evaluation of safety and efficacy o f TUMT with the Dornier urowave (Germering/Germany) in patients with o bstructive benign prostatic hyperplasia (BPH). Between February 1992 a nd August 1994, 83 patients were enrolled and, according to protocol, received one-hour of TUMT under sedoanalgesia. The surgical risk of th ese patients was assessed by the ASA-score. Inclusion criteria were IP SS greater than or equal to 15, maximal uroflow less than or equal to 12 ml/sec and endoscopically confirmed absence of urethral stricture, lobes and the absence of an obstructive middle lobe. Microwave energy was 37.8 W, rectal borderline temperature measured 43.5 degrees C and urethral borderline temperature 44.5 degrees C. Energy and temperature were recorded continuously. IPSS, uroflow, residual urine acid PSA as well as intermediate complications were registered at month 1,3, 6, 9 and 12. Results: Residual urine sank by 67% (p < 0.0001) whereas urof low increased by 43% (p < 0.0001) at month 12. Pressure flow studies ( PURR/DURR) did not reveal a statistically significant difference betwe en the pre- and posttreatment situation. However, these studies were d ifficult as a result of the old age of the patients. Side effects: The rapy was well-tolerated with one exception, side effects were mild and temporary. Because of urinary retention in 21% of the patients, tempo rary urinary diversion became necessary. 14.6% of the patients require d surgery because of increasing symptoms, and indwelling catheter was placed in one patient. 9 patients required permanent care in a foster home or died during follow-up. In summary, the feasability of TUMT in a negatively preselected group of patients due to comorbidity and/or o ld age has been demonstrated. The cost-effectiveness calculation in th ese patients is pending.