title: High-energy transurethral microwave thermotherapy: symptomatic vs urodynamic success.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Urology & Nephrology Centre, Mansoura University, Egypt. y_osman99@yahoo.com
authors.forename: Y
authors.initials: Y
authors.lastname: Osman
authors.forename: B
authors.initials: B
authors.lastname: Wadie
authors.forename: T
authors.initials: T
authors.lastname: El-Diasty
authors.forename: T
authors.initials: T
authors.lastname: Larson
mesh_terms: D000368:Aged; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008872:Microwaves / Q000627:therapeutic use*; D008875:Middle Aged; D009336:Necrosis; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology; D011470:Prostatic Hyperplasia / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D016055:Urinary Retention / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D014554:Urination / Q000502:physiology; D014563:Urodynamics