High-energy transurethral thermotherapy with CoreTherm approaches transurethral prostate resection in outcome efficacy: a meta-analysis.
OBJECTIVE
Minimally invasive office-based treatments for benign prostatic hyperplasia (BPH) are challenging the traditional surgical and medical management options for symptomatic BPH. We conducted a meta-analysis of published randomized controlled trials that compared high-energy transurethral microwave thermotherapy (HE-TUMT) with transurethral resection of the prostate (TURP) to compare subjective and objective outcomes.


METHODS
A literature search using Pub-Med was conducted to obtain all published data on HE-TUMT and all randomized controlled trials that compared HE-TUMT with TURP. Data were analyzed focusing on the pretreatment and posttreatment end points of the International Prostate Symptom Score(IPSS), maximum flow rate (Q(max)), and postvoid residual (PVR). A meta-analysis was conducted, and data were stratified with respect to the type of HE-TUMT machinery used.


RESULTS
A total of 458 patients were studied. Differences in IPSS, Q(max), and PVR from current trials that compared TURP with HE-TUMT are best evaluated at 1-year follow-up. At this time point, changes in Q(max) (P < 0.001), IPSS (P = 0.01), and PVR (P = 0.02) are more significant if TURP is the management mode. HE-TUMT with the CoreTherm() device demonstrates the most significant improvements in subjective and objective criteria that approximate outcomes with TURP (Figs. 1-3).


CONCLUSIONS
A meta-analysis of current randomized controlled trials that compared TURP with HE-TUMT demonstrates more significant changes in Q(max), IPSS, and PVR when TURP is used to manage symptomatic BPH. Despite these statistical differences, stratified data demonstrate that current HE-TUMT machinery is more effective than previously used lower-energy machinery, especially at objective end points. This is most evident when the CoreTherm device is used. These findings, coupled with the decreased costs and morbidity associated with HE-TUMT, support this treatment as a reasonable alternative to TURP.
Kaye
Jonathan D
JD
Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA. Jonathankaye1975@yahoo.com
Smith
Arthur D
AD
Badlani
Gopal H
GH
Lee
Benjamin R
BR
Ost
Michael C
MC
D006801:Humans; D008297:Male; D008872:Microwaves / Q000627:therapeutic use; D011470:Prostatic Hyperplasia / Q000503:physiopathology / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D020728:Transurethral Resection of Prostate / Q000295:instrumentation; D016896:Treatment Outcome; D014554:Urination / Q000502:physiology