Lung-term followup of randomized transurethral microwave thermotherapy versus transurethral prostatic resection study

Purpose: We evaluate the durable effect of high-energy transurethral microw ave thermotherapy and transurethral prostatic resection for treatment of pa tients with lower urinary tract symptoms suggestive of bladder outflow obst ruction. Materials and Methods: Between January 1996 and March 1997, 155 patients wi th lower urinary tract symptoms suggestive of bladder outflow obstruction w ere randomized to receive transurethral microwave thermotherapy (Prostatron * device and commercial software) (82) or undergo transurethral prostatic r esection (73). Initial patient evaluation was performed according to intern ational standards. Patients were followed annually with the International P rostate Symptom Score (I-PSS) and uroflowmetry (maximum flow rate). The Kap lan-Meier survival analysis was used to calculate the cumulative risk of re -treatment, adjusted for loss to followup. Results: A total of 78 patients received transurethral microwave thermother apy and 66 underwent transurethral prostatic resection. Median followup was 33 months. In the thermotherapy group mean maximum urinary flow rate impro ved from 9.2 ml. per second at baseline to 15.1, 14.5 and 11.9 ml. per seco nd at 1, 2 and 3 years, and mean I-PSS decreased from 20 to 8, 9, and 12, r espectively. In the resection group the corresponding numbers for maximum u rinary flow rate were 7.8, 24.5, 23.0 and 24.7 ml. per second at 1, 2 and 3 years, and for I-PSS were 20, 3, 4 and 3, respectively. At 36 months, 14 p atients in the thermotherapy and 8 from the resection groups underwent re-t reatment, and the cumulative risk was 19.8% (95% confidence interval 10.4%, to 29.3% and 12.9% (4.5% to 21.3%), respectively (p = 0.28). Conclusions: Transurethral microwave thermotherapy and transurethral prosta tic resection achieve durable improvement in patients with lower urinary tr act symptoms suggestive of bladder outflow obstruction, while the magnitude of improvement is higher with resection. The repeat thermotherapy is based on failure of therapy whereas repeat resection is based on complications o f therapy.