HOW TO SELECT PATIENTS SUITABLE FOR TRANSURETHRAL MICROWAVE THERMOTHERAPY - A SYSTEMATIC EVALUATION OF POTENTIALLY PREDICTIVE VARIABLES

Objective To identify clinical variables useful in predicting outcome after transurethral microwave thermotherapy (TUMT) of the prostate wit h Prostasoft v. 2.0. Patients and methods Thirty-eight men with sympto matic benign prostatic hyperplasia (BPH) were treated with TUMT using the Prostatron device with the low-energy (v. 2.0) software. Before an d 6 months after treatment symptoms were evaluated using the Madsen-Iv ersen (M-I) symptom score, a clinical examination and suprapubic press ure-now measurement, free urinary peak flow rate (Q(max)) and determin ation of post-void residual urine volume (PVR). Bladder outlet obstruc tion was assessed from urodynamic pressure-now studies using the class ification of Abrams and Griffiths, the obstruction grading of Schafer, and calculation of other published factors, e.g. the urethral resista nce, an obstruction index and the detrusor adjusted mean passive ureth ral resistance factor (DAMPF). Categories of M-I score (total, irritat ive and obstructive), PVR and Q(max) were investigated to determine wh ether any could predict the outcome after low-energy TUMT. The values after treatment and changes in Q(max), M-I score and PVR were used as efficacy variables. Results Variables describing infravesical obstruct ion had predictive characteristics that may be useful in selecting pat ients for TUMT v. 2.0 and significantly better results were obtained i n patients with a low to moderate obstruction as graded using the DAMP F classification of obstruction. The results also indicated that patie nts with a high irritative M-I score or a Q(max) of 7-14 mL/s were tho se who fared best after TUMT. Conclusions Variables expressing the obs truction grade seem to be useful in predicting outcome after TUMT (v. 2.0). Patients with a high obstruction index are probably unsuitable f or TUMT (v 2.0).