Transurethral microwave thermotherapy
Encyclopedia
Transurethral microwave thermotherapy (TUMT) is one of a number of effective and safe procedures used in the treatment of lower urinary tract symptoms
(LUTS) caused by benign prostatic hyperplasia
(BPH). TUMT provides a one-time efficacious treatment of LUTS due to BPH. It is an alternative treatment to pharmacotherapy such as Alpha blocker
s, transurethral resection of the prostate
(TURP), transurethral needle ablation of the prostate
(TUNA), photoselective vaporization of the prostate (PVP) and prostatic removal or prostatectomy
.
The procedure can take from 30 minutes to one hour and is well tolerated by patients. Following the procedure, the prostatic tissue will be swollen and irritated. Urologists often place a Foley catheter
to prevent the patient from having urinary retention. After 3 to 5 days the Foley can be replaced by a temporary prostatic stent to improve voiding without exacerbating irritation symptoms.
Evidence is turning in favour of TUMT over Transurethral resection of the prostate
(TURP).
(IPSS) including Quality of Life, is used to quantify symptoms and to monitor the response to the TUMT treatment. Fortunately post treatment convalescence is relatively rapid, with most patients able to void and a mean recovery time of less than 5 days at home.
However, prostatic edema is expected after microwave therapy, and this can lead to a risk of urinary retention. While some protocols suggest leaving a Foley catheter in for up to 2 weeks in all patients, other urologists are choosing to place a temporary prostatic stent after the first week following treatment. The stent is worn for 30 days and allows the patient to have volitional voiding with improved quality of life versus a Foley catheter. Generally urinary flow improves over a few months.
Patients maintained on alpha-blockers after TUMT may experience fewer urinary symptoms and have a decreased incidence of retention.
Lower urinary tract symptoms
Lower urinary tract symptoms are a common problem affecting approximately 40% of older men. LUTS is a recent term for what used to be known as prostatism.-Voiding or obstructive symptoms:*Poor stream*Hesitancy*Terminal dribbling...
(LUTS) caused by benign prostatic hyperplasia
Benign prostatic hyperplasia
Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
(BPH). TUMT provides a one-time efficacious treatment of LUTS due to BPH. It is an alternative treatment to pharmacotherapy such as Alpha blocker
Alpha blocker
Alpha-1 blockers constitute a variety of drugs which block α1-adrenergic receptors in arteries and smooth muscles.-Pharmacology:...
s, transurethral resection of the prostate
Transurethral resection of the prostate
Transurethral resection of the prostate is a urological operation. It is used to treat benign prostatic hyperplasia . As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection...
(TURP), transurethral needle ablation of the prostate
Transurethral needle ablation of the prostate
Transurethral needle ablation is a technique that uses low energy radio frequency energy delivered through two needles to ablate excess prostate tissue. It can be done with a local anesthetic on an outpatient basis...
(TUNA), photoselective vaporization of the prostate (PVP) and prostatic removal or prostatectomy
Prostatectomy
A prostatectomy is the surgical removal of all or part of the prostate gland. Abnormalities of the prostate, such as a tumour, or if the gland itself becomes enlarged for any reason, can restrict the normal flow of urine along the urethra....
.
Process
TUMT is a non-surgical, minimally invasive therapy that can be performed under a local anesthetic on an outpatient basis. The treatment involves inserting a special microwave urinary catheter into the hyperplastic prostatic urethra. The microwave antenna within the catheter is then heated to destroy the surrounding prostatic tissue.The procedure can take from 30 minutes to one hour and is well tolerated by patients. Following the procedure, the prostatic tissue will be swollen and irritated. Urologists often place a Foley catheter
Foley catheter
A Foley catheter is a flexible tube that is often passed through the urethra and into the bladder. The tube has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out into a collection bag...
to prevent the patient from having urinary retention. After 3 to 5 days the Foley can be replaced by a temporary prostatic stent to improve voiding without exacerbating irritation symptoms.
Risks
The main risks of transurethral microwave thermotherapy (TUMT) include:- Urinary retention
- Infection
- Postprocedural pain.
Evidence is turning in favour of TUMT over Transurethral resection of the prostate
Transurethral resection of the prostate
Transurethral resection of the prostate is a urological operation. It is used to treat benign prostatic hyperplasia . As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection...
(TURP).
Aftercare
Often the International Prostate Symptom ScoreInternational Prostate Symptom Score
The International Prostate Symptom Score is an 8 question written screening tool used to screen for, rapidly diagnose, track the symptoms of, and suggest management of the symptoms of the disease benign prostatic hyperplasia...
(IPSS) including Quality of Life, is used to quantify symptoms and to monitor the response to the TUMT treatment. Fortunately post treatment convalescence is relatively rapid, with most patients able to void and a mean recovery time of less than 5 days at home.
However, prostatic edema is expected after microwave therapy, and this can lead to a risk of urinary retention. While some protocols suggest leaving a Foley catheter in for up to 2 weeks in all patients, other urologists are choosing to place a temporary prostatic stent after the first week following treatment. The stent is worn for 30 days and allows the patient to have volitional voiding with improved quality of life versus a Foley catheter. Generally urinary flow improves over a few months.
Patients maintained on alpha-blockers after TUMT may experience fewer urinary symptoms and have a decreased incidence of retention.
See also
- Benign prostatic hyperplasiaBenign prostatic hyperplasiaBenign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
- Lower urinary tract symptomsLower urinary tract symptomsLower urinary tract symptoms are a common problem affecting approximately 40% of older men. LUTS is a recent term for what used to be known as prostatism.-Voiding or obstructive symptoms:*Poor stream*Hesitancy*Terminal dribbling...
- Prostate cancerProstate cancerProstate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
- International Prostate Symptom ScoreInternational Prostate Symptom ScoreThe International Prostate Symptom Score is an 8 question written screening tool used to screen for, rapidly diagnose, track the symptoms of, and suggest management of the symptoms of the disease benign prostatic hyperplasia...
- Prostatic stentProstatic stentA prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms . Prostatic obstruction is a common condition with a variety of etiologies...
- Alpha blockerAlpha blockerAlpha-1 blockers constitute a variety of drugs which block α1-adrenergic receptors in arteries and smooth muscles.-Pharmacology:...
- Transurethral resection of the prostateTransurethral resection of the prostateTransurethral resection of the prostate is a urological operation. It is used to treat benign prostatic hyperplasia . As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection...
- Transurethral needle ablation of the prostateTransurethral needle ablation of the prostateTransurethral needle ablation is a technique that uses low energy radio frequency energy delivered through two needles to ablate excess prostate tissue. It can be done with a local anesthetic on an outpatient basis...
- ProstatectomyProstatectomyA prostatectomy is the surgical removal of all or part of the prostate gland. Abnormalities of the prostate, such as a tumour, or if the gland itself becomes enlarged for any reason, can restrict the normal flow of urine along the urethra....
- Microwave thermotherapyMicrowave thermotherapyMicrowave thermotherapy, also called microwave therapy, is a type of treatment in which body tissue is heated by microwave irradiation to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs.- External links :* entry in the...