Efficacy of high-energy transurethral microwave thermotherapy in alleviating medically refractory urinary retention due to benign prostatic hyperplasia.
OBJECTIVE
To determine the efficacy of high-energy transurethral microwave thermotherapy (HE-TUMT) in treating patients with medically refractory complete urinary retention secondary to benign prostatic hyperplasia (BPH).


METHODS
Between April 2000 and July 2003, 39 patients in urinary retention due to BPH were treated with HE-TUMT. A Foley catheter was reinserted after HE-TUMT and removed at 3 weeks for a voiding trial. Patients unable to void were recatheterized, and voiding trials were repeated at 2-week intervals. Patients were evaluated according to history and physical examination, prostate-specific antigen level, prostate volume, cystourethroscopy, International Prostate Symptom Score, quality of life score, peak uroflow, and postvoid residual. Success was defined as the ability to urinate after HE-TUMT without the need for further intervention.


RESULTS
The mean (+/- SD) patient age was 72 +/- 9.3 years. Mean follow-up period was 18 +/- 10.2 months. Twenty patients (51%) were characterized as American Society of Anesthesiologists class III or higher. The mean prostate volume was 75.2 +/- 57.6 cm3. The mean length of time that patients were dependent on indwelling Foley catheters before HE-TUMT was 9.6 +/- 14.2 weeks. Thirty-two patients were able to void after HE-TUMT, for an overall success rate of 82%. Patients voiding successfully after HE-TUMT had a mean of 1.6 +/- 0.8 voiding trials and required catheters after HE-TUMT for a mean period of 4.1 +/- 2 weeks. Only 6 (15%) of the patients who were voiding were able to stop their medication for BPH.


CONCLUSIONS
We found an encouraging success rate with HE-TUMT in relieving urinary retention in patients with BPH, including those with large prostate volumes. It is an acceptable option for patients who are considered high risk for surgery. Several patients required multiple voiding trials before spontaneous urination, which suggests that improvements in bladder outlet obstruction might require a prolonged period after HE-TUMT. Finally, many patients might require continued use of medications after HE-TUMT.
Kellner
Daniel S
DS
Section of Urology, Lenox Hill Hospital, New York, New York, USA.
Armenakas
Noel A
NA
Brodherson
Michael
M
Heyman
Jacob
J
Fracchia
John A
JA
D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D015897:Comorbidity; D004823:Epididymitis / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011470:Prostatic Hyperplasia / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000601:surgery; D016055:Urinary Retention / Q000209:etiology / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology
D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists