Pressure-flow studies before and after transurethral microwave thermotherapy of benign prostatic hyperplasia using low- and high-energy protocols

Objective To compare pressure-flow results before and 3 months after transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH), per formed with lower and higher energy protocols. Patients and methods Twenty-four patients were treated using a high-energy protocol performed with a heat-shock strategy, i.e, a rapid increase in intraprostatic temperatures to a maximum of 55-67 degrees C. A helical antenna was used which produced maximum heating at the base of the prostate. A further 25 patients were treated using a lower energy protocol with a slow increase in intraprostatic temperatures to a maximum of 45-53 degrees C. A first-generation filament antenna was used with the maximum heat produced at the prostatic apex. All treatments were performed as single-session outpatient procedures of 60-70 min duration. Results There was a significantly greater improvement in pressure-flow variables, i.e. maximum urinary flow rate, detrusor pressure at maximum flow and minimal urethral opening pressure, in those treated with higher energy TUMT than in those receiving the lower energy protocol. The Madsen and quality-of-life scores, and maximum urinary flow rate on uroflowmetry, were also significantly better in the higher energy group. Conclusion Higher energy TUMT performed using a heat-shock strategy provides a better pressure-flow outcome than lower energy thermotherapy. Compared with previously published results, the outcome after higher energy TUMT is at least similar to other treatment alternatives for BPH.