Prevention of temporary prostatic obstruction after high-energy transurethral microwave thermotherapy by placement of an intraurethral prostatic bridge-catheter.

Objectives : The clinical utility of a novel intraurethral prostatic bridge -catheter (PBC) was evaluated for prevention of temporary prostate obstruct ion following targeted high-energy transurethral microwave thermotherapy (T UMT) in patients tr,with benign prostatic hyperplasia (BPH). Material and Methods : High-energy TUMT was administered to 54 BPH patients under topical urethral anesthesia followed by placement of a PBC, which re mained indwelling up to 1 month. Patient evaluation included determination of peak urinary flow rate (Q(max)), International Prostate Symptom Score (I PSS), and guality of life (QOL) score at baseline, iininediately following TUMT and PBC placement, and at periodic intervals thereafter up to 1 month. Results were compared retrospectively with those of 51 patients who underwe nt TUMT followed,ed by standard temporary urinary cathererization, generall y for 24 h. Results : Irnmediately following TUMT and PBC placement signifi cant improvements (p < 0.0005) were observed in mean Q(max) IPSS and QOL sc ore of 59.3%, 33.5% and 23.6% respectively, compared with baseline values. Further improvements were demonstrable up to 1 month, at which time mean Q( max), IPSS and QOL score had improved 79.0%, 54.9% and 56.5%, respectively vs baseline means (p < 0.0005). In a retrospective comparison at baseline a nd 14 days between PBC recipients (PBC group) and a cohort of TUMT patients who had undergone temporary standard catheterization and subsequent cathet er removal (standard catheterization group), mean baseline Q(max), IPSS and QOL score were similar between the two groups. However at the 14 day follo w-up evaluation in the PBC group mean Q(max), was 101.8% higher find IPSS a nd QOL score were 47.9% and 51.1% lower respectively than the corresponding values in the standard catheterization group (p 0.0005). The PBC was well tolerated and remained in situ throughout the entire 1 month follow-up peri od in 48/54 (88.9%) patients. Early PBC removal was performed in 3/54 patie nts (5.6%) because of urinary retention and irt 3/54 patients (5.6%) due to PBC migrrrtion. During the acute post-TUMT recovery period PBC recipients experienced impairment in sexual function which, though statistically signi ficant, was comparatively small in magnitude. Conclusion : PBC provides an efficacious and well-tolerated option for prev enting prostatic obstruction in the acute post-TUMT period. This approach a voids the inconvenience and infection risk of standard indwelling catheters or intermittent self-catheterization. PBC insertion and removal are rapid facile and non-traumatic. PBC placement may prove useful in improving the e arly results of TUMT.