Temporary intraurethral prostatic bridge-catheter compared with neoadjuvant and adjuvant alpha-blockade to improve early results of high-energy transurethral microwave thermotherapy
B. Djavan et al., Temporary intraurethral prostatic bridge-catheter compared with neoadjuvant and adjuvant alpha-blockade to improve early results of high-energy transurethral microwave thermotherapy, UROLOGY, 54(1), 1999, pp. 73-80
Objectives. The maximal effect of transurethral microwave thermotherapy (TU
MT) for lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia
(BPH) occurs 3 to 6 months after treatment. In the acute period after TUMT
, little change in symptoms, quality of life (QOL), and peak urinary flow r
ate (Qmax) is observed versus baseline. Some men may also develop acute uri
nary retention secondary to thermally induced edema. Recent reports suggest
that early results of TUMT may be improved with concomitant use of either
a temporary intraurethral prostatic bridge-catheter (PBC) or neoadjuvant an
d adjuvant alpha-blocker therapy. This report compares the results of these
two adjunctive modalities directly.
Methods. This nonrandomized retrospective comparison of results in 186 pati
ents with LUTS of BPH is based on findings of three recently reported prosp
ective clinical trials. All patients underwent targeted high-energy TUMT. N
inety-one patients received no further treatment (TUMT alone group), 54 an
indwelling PBC for up to 1 month (TUMT + PBC group), and 41 neoadjuvant and
adjuvant tamsulosin (0.4 mg daily) treatment (TUMT + tamsulosin group). Th
e International Prostate Symptom Score (IPSS), QOL score, and Qmax were det
ermined at baseline and 2 weeks after TUMT.
Results. All three study groups experienced statistically significant impro
vements in mean IPSS and QOL score at 2 weeks versus baseline (P <0.0005).
Nevertheless, the magnitude of improvement was greater in the TUMT + PBC gr
oup than the other two groups and greater in the TUMT + tamsulosin group th
an the TUMT alone group. A high proportion of the TUMT + PBC group (87.8%)
attained a 50% or more IPSS improvement, compared with 4.5% of the TU MT al
one group and none of the TU MT + tamsulosin group, and a similar pattern o
f between-group differences was noted with respect to the proportion of pat
ients having 50% or more improvement in QOL score. The TUMT + PBC group was
the only group to achieve significant Qmax improvement at 2 weeks compared
with baseline. In the TUMT alone group, urinary retention 1 week or longer
in duration occurred in 10 (11%) of 91 patients compared with 1 (2.4%) of
41 in the TUMT + tamsulosin group and none in the TUMT + PBC group. Early P
BC removal was required in 11% of the TUMT + PBC group as a consequence of
urinary retention secondary to clot formation or PBC migration.
Conclusions. Both PBC placement and neoadjuvant and adjuvant alpha-blocker
treatment are effective in alleviating symptoms and improving QOL during th
e acute period after TUMT. PBC usage also resulted in substantial early Qma
x improvement. Either of these adjunctive modalities may be appropriate to
consider in the treatment of TUMT patients during the early postprocedure r
ecovery period. UROLOGY 54: 73-80, 1999. (C) 1999, Elsevier Science Inc.