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High‐energy transurethral microwave thermotherapy: symptomatic vs urodynamic success
Author(s) -
Osman Y.,
Wadie B.,
ElDiasty T.,
Larson T.
Publication year - 2003
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.2003.04079.x
Subject(s) - medicine , nomogram , magnetic resonance imaging , urology , hyperplasia , transrectal ultrasonography , nuclear medicine , prostate , surgery , radiology , cancer
OBJECTIVE To evaluate the subjective and objective treatment results of high‐energy transurethral microwave thermotherapy (TUMT) for symptomatic benign prostatic hyperplasia (BPH), and investigate the possible variables for predicting symptomatic and/or urodynamic success. PATIENTS AND METHODS Between October 1998 and October 2000, 40 men with BPH underwent high‐energy TUMT using the Targis device (Urologix, Inc., Minneapolis, MN, USA). Evaluation after treatment included a clinical determination of the symptom score, a urodynamic assessment by peak flow rate and pressure‐flow, magnetic resonance imaging (MRI), transrectal ultrasonography and endoscopy. The objective and subjective success was correlated with several variables before, during and after treatment. RESULTS All patients completed at least 1 year of follow‐up after TUMT as monotherapy. The symptom score improved from a median (range) of 20.5 (11–28) initially to 9 (0–28) ( P < 0.001). Twenty‐two patients (55%) had a marked and 11 (28%) a moderate response, giving an overall subjective success rate of 83%. Similarly, there was a significant improvement in peak flow rate, from 9.2 (4.4–13.4) to 15 (3.3–22.9) mL/s ( P < 0.001). Twenty‐one patients (53%) had a maximum flow rate of> 15 mL/s while in eight (20%) it was 10–15 mL/s. Only 20 patients changed from unobstructed on the pressure‐flow nomogram, i.e. an overall objective success rate of 50%. Gadolinium‐enhanced T1‐weighted MRI 1 week after treatment showed a median (range) perfusion defect of 20.7 (5.5–76.6)% of the total gland volume. Despite this persisting in all patients, a well‐defined cavity was apparent in only in seven (18%) at the final evaluation. Cystoscopy 1 month after therapy showed evidence of necrotic tissue occupying the prostatic fossa in all patients. Younger patients were more likely to be urodynamically successful, and a higher grade of obstruction predicted symptomatic success. CONCLUSION High‐energy TUMT can induce considerable necrosis of the prostate, as shown by MRI and cystoscopy. Although there was an adequate improvement in most patients' symptoms, there was a successful urodynamic change to unobstructed in only half the patients. Younger patients and those with a higher grade of obstruction were more likely to have urodynamic and symptomatic success, respectively.