Abstract

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• Transurethral microwave thermotherapy of the prostate has been touted as a minimally invasive means of treating symptomatic prostatism. High temperatures (>55°C) appear to yield improved results but require general anesthesia. To determine if high temperature thermotherapy of the prostate was feasible in an outpatient, nonanesthetic setting, we subjected men with symptomatic prostatism secondary to benign prostatic hyperplasia to treatment with a newly developed circumferentially cooled transurethral microwave thermotherapy device, the UroWave®. Intraprostatic temperatures were measured on-line and treatment was targeted to achieve temperatures ranging from 45°C-65°C. Fifty-five men with benign prostatic hyperplasia underwent transurethral microwave thermotherapy using the UroWave® in an outpatient setting without general anesthesia. Baseline mean peak urinary flow rates were 8.0 cc/sec and mean American Urology Association of the prostate displayed three distinct phases: an initial slow heating phase, a plateau phase of variable duration and a rapid secondary heating phase. The final intraprostatic temperature did not correlate with urethral or rectal temperatures or the amount of power applied. At six months, peak flow increased by 50% and symptoms score declined by 52%. Ninety-four percent of patients had a transurethral resection of the prostate-like defect at cystoscopy with a greater proportion at higher temperatures. Side effects were rare and no patients had to be admitted to hospital. Transurethral microwave thermotherapy at high intraprostatic temperatures can be achieved with general anesthesia. Symptom relief was considerable and anatomic changes resembling a transurethral resection of the prostate were noted in the majority of patients. Intraprostatic temperatures are the only means of assessing the thermal damage to the prostate and thus the effectiveness if therapy. Future studies must develop less invasive means of monitoring intraprostatic temperatures and define the role of the bladder neck. Ultimately, randomized controlled trials will define the value of this treatment.