Transurethral thermotherapy for benign prostatic hyperplasia significantlydecreases infravesical obstruction: Results in 134 patients after 1 year

Purpose: We prospectively evaluated a decrease in outflow obstruction cause d by benign prostatic hyperplasia (BPH) with second generation thermotherap y. Materials and Methods: Transurethral microwave therapy was given with local anesthesia to 134 patients with urodynamically and cystoscopically documen ted obstruction by BPH and preserved detrusor function. Of 134 patients 67 (50%) had a general health score of 3 or greater. Results: Urgency was the main complaint during thermotherapy. After a media n followup of 24 months (minimum 12) 100 patients were evaluable at 6 and 1 2 months. Of the initial 134 patients 17 (13%) who required additional trea tment (repeat thermotherapy, transurethral prostatic resection, permanent c ystostomy), 7 who died during followup for treatment unrelated reasons and 10 who were lost to followup or refused evaluation were excluded from furth er analysis. Mean International Prostate Symptom Score decreased from 22.5 before to 3.6 at 6 months after treatment and remained stable at 12 months. Mean Quality of Life Index improved from 4.3 before to 1 at 12 months after treatment. Mean maximum flow increased from 7.3 mi. per second before to 14.5 at 6 mon ths and 13.9 at 12 months after treatment. Mean post-void residual decrease d from 199 to 34.8 and 37.2 mi, at 6 and 12 months, respectively. Urodynamic evaluation of 84 patients after 6 months revealed a decrease in mean detrusor opening pressure from 96.8 to 53 cm. water and mean detrusor pressure at maximum flow from 99.8 to 59.7 rm. water. Mean ultrasonographic prostate volume decreased from 57.6 to 42.4 cc and a cavity in the prostat e was documented in 65 of the 84 cases (77%). All changes between the pretr eatment and posttreatment values at 6 and 12 months, respectively, were sta tistically significant (paired t test p < 0.00001). Conclusions: Targeted transurethral thermotherapy with second generation mi crowave equipment is minimally invasive, easy to apply and generally well t olerated with local anesthesia. Infravesical outlet obstruction and voiding pressures as assessed by pressure now studies significantly decreased 6 mo nths after treatment. Subjective voiding symptoms as well as post-void resi dual urine were significantly decreased, and urinary flow was improved 6 an d 12 months after treatment of documented BPH.