eMedicine Specialties > Urology > Benign Prostatic Hypertrophy

Transurethral Microwave Thermotherapy of the Prostate (TUMT): Follow-up

Author: Jonathan Rubenstein, MD, Staff Physician, Department of Urology, University of California, San Francisco
Coauthor(s): Kevin T McVary, MD, Associate Professor, Department of Urology, Northwestern University Medical School
Contributor Information and Disclosures

Updated: Feb 6, 2008

Outcome and Prognosis

Urologists and patients can be overwhelmed with information and results from various different instruments. Unfortunately, it is difficult if not impossible to truly evaluate the efficacy of one treatment over another. Most transurethral microwave thermotherapy (TUMT) studies involve a limited number of patients, short follow-up, or an inherent selection or reporting bias. Therefore, all data must be interpreted with caution.

TUMT has been compared with sham (placing the catheter but not running the program), showing a decrease in symptom scores of an average of 11 points (compared to 5 with sham) at 6 months in 220 patients. Selected groups have a reported significant symptomatic improvement of up to 24 months using the Targis machine, with a similar improvement in quality of life. In these studies, the mean maximum flow rate increased from 7.3 mL/s to 14.5 mL/s at 6 months, remaining stable at 1 year. The mean postvoid residual decreased from 199 mL to 34.8 mL at 6 months, which also remained stable at 12 months. Prostatic volume decreased from 57 mL to 42 mL, and cavitation was observed in 77% of patients. A substantial decrease in voiding pressures occurred. Only 13% of patients required retreatment within 1 year.

The low-energy Prostasoft 2.0 yielded early symptomatic improvement that was not durable and that did not have a complementary objective improvement, with two-thirds requiring supplemental treatment. Higher-energy protocols have resulted in objective flow rate improvement in addition to symptomatic improvement. In 2000, de la Rosette et al reported that, 6 months after treatment with Prostasoft 3.5, the IPSS decreased by 11 points, with an increase in maximum flow rate of 5 mL/s.5 Indwelling catheter time postprocedure was 18 days. No serious complications occurred.

Similarly, the ProstaLund Feedback Treatment has been compared with TURP and has not shown inferior outcomes, but selection and reporting bias and a limited number of patients inhibit one from truly being able to use this data in a meaningful manner.

When compared with alpha-blocker therapy, TUMT is associated with a slower symptomatic improvement (6 mo vs 6 wk) of symptoms but better long-term results. Alpha-blockade alone appears to be associated with a higher number of adverse effects.

When compared with the criterion standard TURP, 6 studies with a sufficient number of patients for comparison have been published. Symptomatic improvement and durability was greater after TURP than after TUMT, with a complementary better objective response as measured by maximal flow rate. TUMT yielded a lower incidence of retrograde ejaculation, newly onset erectile dysfunction, TURP syndrome, clot retention, and transfusion requirement.

In patients presenting with urinary retention, TUMT was originally considered to be insufficient therapy. Many of these patients, however, were older, had a larger prostate volume, and had more surgical comorbidities, making this subset more likely to benefit from a minimally invasive option. With the advent of high-energy TUMT, patients are now offered this less-invasive therapy, with a catheter-free rate of 82-91% in selected patients, although most also must continue medical therapy.

In conclusion, TUMT is a safe and effective minimally invasive alternative treatment for symptomatic benign prostatic hypertrophy (BPH). TUMT can be performed in a 1- to 2-hour office visit without intravenous sedation. This is an alternative for patients who are at high surgical and anesthetic risk. It is not effective for patients with a large median lobe or a very large prostate, and it results in less significant improvement in urinary flow patterns than TURP.

Future and Controversies

Microwave therapy may be of value to treat other types of prostate pathology, such as chronic prostatitis, with one study reporting a 25% complete and sustained improvement and a 50% rate of mild improvement in 45 patients.

In the future, with further evolution of the devices and knowledge of treatment outcomes, patients may be better stratified to determine the optimal therapy choice. The long-term results of the balance between patient tolerability and efficacy need to be evaluated adequately in a controlled setting. To address some of the uncertainty when comparing treatment modalities, the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases have begun a collaborative project with 7 academic urology centers named the MIST Trial. The results are pending.

Enthusiastic reassessment of procedures that may reduce local and overall morbidity and maintain or improve immediate and long-term physiologic results is understandable and laudable. Currently, assessment of these efforts is hampered by the limited number of patients, the evolving selection and technical approaches, and the limited follow-up period and nature of the follow-up information provided. In summary, transurethral microwave thermotherapy (TUMT), a minimally invasive therapy, appears to balance efficacy against tolerability, and this balance might be tenuous for patients long-term.

 


More on Transurethral Microwave Thermotherapy of the Prostate (TUMT)

Overview: Transurethral Microwave Thermotherapy of the Prostate (TUMT)
Workup: Transurethral Microwave Thermotherapy of the Prostate (TUMT)
Treatment: Transurethral Microwave Thermotherapy of the Prostate (TUMT)
Follow-up: Transurethral Microwave Thermotherapy of the Prostate (TUMT)
Multimedia: Transurethral Microwave Thermotherapy of the Prostate (TUMT)
References
Further Reading
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Further Reading

For additional information, visit Medscape’s BPH Resource Center.

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Keywords

transurethral microwave thermotherapy of the prostate, TUMT, hyperthermia, thermotherapy, thermoablation, benign prostatic hypertrophy, microwave therapy, prostatism, lower urinary tract symptoms, LUTS, BPH, transurethral resection of the prostate, TURP, Targis system, Targis machine, Prostasoft 2.0, Prostasoft 2.5, Prostasoft 3.5, open prostatic enucleation, open prostatectomy, adenomatous hyperplasia, nocturia, urinary frequency, urgency, dysuria, urinary tract infection, bladder stones, renal failure, hydronephrosis, microscopic hematuria, gross hematuria, neurogenic voiding dysfunction, urethral stricture, prostatitis, urinary bladder, high-energy transurethral microwave thermotherapy of the prostate, high-energy TUMT

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Contributor Information and Disclosures

Author

Jonathan Rubenstein, MD, Staff Physician, Department of Urology, University of California, San Francisco
Jonathan Rubenstein, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Coauthor(s)

Kevin T McVary, MD, Associate Professor, Department of Urology, Northwestern University Medical School
Kevin T McVary, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Andrology, American Urological Association, Chicago Medical Society, Illinois State Medical Society, and Society of Urologic Oncology
Disclosure: Nothing to disclose.

Medical Editor

Bradley Fields Schwartz, DO, FACS, Associate Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Stephen W Leslie, MD, FACS, Founder and Medical Director of the Lorain Kidney Stone Research Center, Clinical Assistant Professor, Department of Urology, Medical College of Ohio
Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, National Kidney Foundation, and Ohio State Medical Association
Disclosure: Nothing to disclose.

 
 
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