Transurethral microwave thermotherapy (TUMT) is one of a number of effective and safe procedures used in the treatment of

lower urinary tract symptoms Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra and, in men, the prostate. The term is more commonly applied to men—over 40% of older men are afected—but lower urin ...

caused by

benign prostatic hyperplasia Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss o ...

. It is an alternative treatment to pharmacotherapy such as

alpha blocker Alpha (uppercase , lowercase ; grc, ἄλφα, ''álpha'', or ell, άλφα, álfa) is the first letter of the Greek alphabet. In the system of Greek numerals, it has a value of one. Alpha is derived from the Phoenician letter aleph , which ...

transurethral resection of the prostate Transurethral resection of the prostate (commonly known as a TURP, plural TURPs, and rarely as a transurethral prostatic resection, TUPR) is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, ...

(TURP),

transurethral needle ablation of the prostate Transurethral needle ablation (also called TUNA or transurethral radiofrequency ablation) is a technique that uses low energy radio frequency delivered through two needles to ablate excess prostate tissue. A cystoscope/catheter deploys the needl ...

, photoselective vaporization of the prostate and prostatic removal or

prostatectomy Prostatectomy (from the Ancient Greek language, Greek , "prostate" and , "excision") as a medical term refers to the surgical removal of all or part of the prostate gland. This operation is done for benignity, benign conditions that cause urina ...

Process

Transurethral microwave thermotherapy is a non-surgical, minimally invasive therapy that can be performed under a local anesthetic on an outpatient basis. The treatment involves inserting a special microwave urinary catheter into the hyperplastic prostatic urethra. The microwave antenna within the catheter then emits microwaves to heat and destroy the surrounding prostatic tissue. The procedure can take from 30 minutes to one hour and is well tolerated by patients. Following the procedure, the prostatic tissue will be swollen and irritated. Urologists often place a

Foley catheter In urology, a Foley catheter (named for Frederic Foley, who produced the original design in 1929) is a flexible tube that a clinician passes through the urethra and into the bladder to drain urine. It is the most common type of indwelling urina ...

to prevent the patient from having urinary retention. After three to five days the Foley catheter can be replaced by a temporary prostatic stent to improve voiding without exacerbating irritation symptoms.

Benefits

According to a Cochrane review from 2012, TUMT may be effective at safely improving symptoms, however, TUMT does not appear to be as effective as a surgical approaches such as TURP and may be associated with a greater need for retreatment when compared to

(TURP). Nevertheless, TUMT is associated with fewer serious side effects compared to TURP.

Harms

The main risks of transurethral microwave thermotherapy include: * Acute urinary retention *

Urinary tract infection A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...

* Pain during and after the procedure *

Retrograde ejaculation Retrograde ejaculation occurs when semen which would be ejaculated via the urethra is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation, sealing the bladder which besides inhibiting the releas ...

* Urination pain after the procedure

Aftercare

The

International Prostate Symptom Score The International Prostate Symptom Score (IPSS) is an eight-question written screening tool used to screen for, rapidly diagnose, track the symptoms of, and suggest management of the lower urinary tract symptoms of benign prostatic hyperplasia (BPH ...

including a

quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...

survey, is often used to quantify symptoms and to monitor the response to the treatment. Convalescence is relatively rapid, with most patients able to void and a mean recovery time of less than 5 days at home. However, prostatic

edema Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's Tissue (biology), tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels t ...

is expected after microwave therapy, and this can lead to a risk of urinary retention. While some protocols suggest leaving a Foley catheter in for up to 2 weeks in all patients, other urologists are choosing to place a temporary

prostatic stent A prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms (LUTS). Prostatic obstruction is a common condition with a variety of causes. Beni ...

after the first week following treatment. The stent is worn for 30 days and allows the patient to have volitional voiding with improved quality of life compared to a Foley catheter. Urinary flow generally improves over a few months. Patients maintained on alpha-blockers after transurethral microwave thermotherapy may experience fewer urinary symptoms and have a decreased incidence of retention.

Judgements in guidelines

* The

American Urological Association The American Urological Association (AUA) is a professional association in the United States for urology professionals. It has its headquarters at the William P. Didusch Center for Urologic History in Maryland. AUA works with many international o ...

(AUA) guidelines for the treatment of BPH from 2018 stated that TUMT may be offered to patients provided they are informed that it is associated with a higher risk of necessary retreatment compared to TURP. * The

European Association of Urology The European Association of Urology (EAU) is a non-profit organisation committed to the representation of urology professionals worldwide. All active urology professionals, including urology nurses, are eligible for membership of the EAU. The con ...

(EAU) has - as of 2019 - removed TUMT from its guidelines.EAU: ''Management of Non-neurogenic Male LUTS - Summary of Changes 2019''

References