Transurethral microwave thermotherapy: An alternative to medical management in patients with benign prostatic hyperplasia?

Transurethral microwave thermotherapy (TUMT) is being increasingly consider ed as an alternative to medical management with alpha -blockers or finaster ide in patients with lower urinary tract symptoms (LUTS) of benign prostate hyperplasia (BPH), Enduring clinical benefits have been demonstrated after a single 1-hour microwave treatment session under topical anesthesia, and the associated morbidity is low, Optimal results are obtained with the deli very of high thermal doses and accurate targeting of microwave energy. Exte nsive evidence from randomized clinical trials supports the safety and effi cacy of both microwave treatment and medical management, but randomized tri al data have only recently become available directly comparing these two ap proaches to BPH treatment. These data indicate that greater long-term impro vements in symptoms, peak urinary flow rates, and quality of life are attai ned with microwave treatment than with alpha -blockade, Furthermore, the ac tuarial rate of treatment failure is markedly lower in patients undergoing microwave nu alpha -blocker treatment. However, the onset of action of alph a -blocker treatment is more rapid. The principal limitations of alpha -blo ckade are side effects and lack of efficacy leading to treatment failure in some patients, The maximal effects of finasteride are modest and require a period of months to be manifested, although the side effect profile and to lerability of this agent are favorable. Neoadjuvant and adjuvant alpha -blo cker therapy can accelerate symptom and flow rate improvement after TUMT, I n contrast to medical management, microwave treatment is highly versatile, allowing patients over a broad range of baseline symptom severities and pro state sizes to be treated with a high probability of success.