Neoadjuvant and adjuvant alpha-blockade improves early results of high-energy transurethral microwave thermotherapy for lower urinary tract symptoms of benign prostatic hyperplasia: A randomized, prospective clinical trial

Objectives. Improved long-term results with respect to symptoms, voiding fu nction, and quality of life (QOL) in patients with lower urinary tract symp toms (LUTS) of benign prostatic hyperplasia (BPH) are achieved with targete d high-energy transurethral microwave thermotherapy (TUMT) compared with al pha-blocker treatment alone. However, maximal improvement after TUMT is not attained until 3 to 6 months after treatment. Measures to provide earlier symptom relief and improved voiding function and QOL would add to the clini cal utility of TUMT. The objective of the present study was to determine wh ether neoadjuvant and adjuvant alpha-blockade is capable of accelerating a post-TUMT decrease in LUTS of patients with BPH. Methods. In this randomized, prospective study of 81 patients with LUTS of BPH, 41 underwent TUMT with neoadjuvant and adjuvant tamsulosin (0.4 mg dai ly) treatment, and 40 had TUMT alone. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and QOL score were determined before treatment and at periodic intervals thereafter up to 12 weeks after TUMT. Results. Mean IPSS values in the TUMT plus tamsulosin group at 2 weeks (14. 0, 95% confidence interval [CI] 13.1 to 14.9) and 6 weeks (8.6; 95% CI 7.7 to 9.5) were 15% and 24% lower, respectively, than those at 2 weeks (16.5, 95% CI 15.6 to 17.4) and 6 weeks (11.3, 95% CI 10.4 to 12.2) in the TUMT-al one group (P < 0.0005). However, by the final evaluation at 12 weeks, no si gnificant difference between the groups in mean IPSS was evident. A similar temporal pattern of difference between the two study groups was also obser ved in QOL score. No significant between-group difference in mean Qmax was evident after TUMT. Urinary retention 1 week or more in duration occurred i n 5 (12%) of 40 TUMT-alone group patients compared with 1 (2%) of 41 TUMT p lus tamsulosin group patients. Conclusions. Neoadjuvant and adjuvant alpha-blocker treatment results in si gnificantly greater early symptom reduction and QOL score improvement after TUMT, adding to the clinical utility of this minimally invasive treatment modality. In addition, post-TUMT complications such as urinary retention ma y be reduced. (C) 1999, Elsevier Science Inc. All rights reserved.