Transurethral microwave thermotherapy for benign prostate hyperplasia: separating truth from marketing hype.
OBJECTIVE
Transurethral microwave thermotherapy (TUMT) is being used with increasing frequency by urologists as a minimally invasive therapy for benign prostatic hyperplasia (BPH). There are various modifications to this technology, with each manufacturer touting safety and efficacy. We review the rationale of TUMT, as well as the historical safety and efficacy of this approach.


METHODS
We reviewed the medical literature, including peer reviewed articles and abstracts. In addition, we analyzed promotional material distributed by various manufacturers with respect to scientific accuracy.


RESULTS
TUMT results in consistent improvement in symptoms and peak urinary flow rate. Symptom improvement ranges between 9 and 11 points, compared to a 6-point improvement in sham treated patients, and peak urinary flow rate increases 3 to 5 ml per second. The degree of coagulation necrosis is different among the various TUMT devices. Although coagulation necrosis is believed to be an important proxy for clinical success, there are few data that correlate this factor with the magnitude of either symptomatic or uroflow improvement.


CONCLUSIONS
TUMT is a safe and effective therapy for the treatment of lower urinary tract symptoms secondary to BPH. In addition, there are distinct advantages to each of the devices. However, intense marketing and hyperbole have dominated this segment of the BPH market. Ultimately, the most effective TUMT device can only be determined by direct comparison studies.
Walmsley
Konstantin
K
Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Kaplan
Steven A
SA
D000329:Advertising; D020684:Cystoscopes / Q000009:adverse effects; D004869:Equipment Safety; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000295:instrumentation; D008297:Male; D011470:Prostatic Hyperplasia / Q000628:therapy*; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000628:therapy*