TRANSURETHRAL THERMOTHERAPY FOR BENIGN PROSTATIC HYPERPLASIA SIGNIFICANTLY DECREASES INFRAVESICAL OBSTRUCTION: RESULTS IN 134 PATIENTS AFTER 1 YEAR

Benign Prostatic Obstruction Relief in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Enlargement Undergoing Endoscopic Surgical Procedures or Therapy with Alpha-Blockers: A Review of Urodynamic Studies

Benign prostatic obstruction (BPO) contributes to the genesis of lower urinary tract symptoms as well as to pathologic remodeling of the lower and upper urinary tract in patients with benign prostate enlargement. Urodynamic studies demonstrate that both medical therapy with alpha-blockers (ABs) and endoscopic surgical procedures provide BPO relief. However, the magnitude of improvement is higher after surgery. Among ABs, silodosin is associated with the highest improvement of bladder outlet obstruction index (BOOI). A complex relationship exists between BOOI improvement and variations of both maximum urinary flow (Q _max) and detrusor pressure. When the reduction of BOOI is small, the improvement of Q _max is clinically irrelevant and the BOOI is mainly influenced by a decrease of detrusor pressure. In contrast, when the magnitude of BOOI reduction is robust, a meaningful improvement of both detrusor pressure and urinary flow is evident. When clustering ABs according to their receptor pharmacologic selectivity and urodynamic efficacy, three subgroups can be identified,with silodosin being the only member of a subgroup characterized by the highest levels of BOOI improvement and α-1A/α-1B receptor affinity ratio.

A single low dose of cadmium exposure induces benign prostate hyperplasia like condition in rat: A novel benign prostate hyperplasia rodent model

Abnormal prostate growth is the most prevalent pathological sign in aged human males, as reflected by high incidence of benign prostate hyperplasia (BPH) and prostate cancer. In spite of the high prevalence, the etiology and pathophysiology of BPH is unclear due to the lack of any established rodent model for study. It has been demonstrated that the cadmium (Cd) mimics the activity of androgen or estrogen by interacting with the steroid hormone receptors in the prostate and elicits BPH, but the specific receptor which binds to Cd is still unknown. Our lab studies with BPH patients highlighted a strong co-relation between smokings with increased Cd content. Changes in the maximum urinary flow rate (Qmax) and prostatic acid phosphatase (PAP) level further supports that Cd can induce BPH like condition. Therefore, the present study was aimed to induce BPH like condition in rats by Cd administration. The dose of cadmium was standardized in an age- and time-dependent manner, which was further examined by prostate weight, histology, and PAP levels that elucidated the pathogenesis of BPH. Further to understand the molecular basis, steroid hormone receptor antagonist experiment was performed. Gene expression and immunohistochemistry data suggest that Cd induces hyperplasia like condition by activating the androgen receptor and estrogen receptor-α and suppresses the action of estrogen receptor-β. The experimental model used here is a cost effective, less time consuming and potentially valuable tool for investigating the respective functions of epithelial and stromal hormone receptors. The applicability of this model would be helpful in understanding the pathogenesis of BPH and its progression.

Rotoresection versus transurethral resection of the prostate: short-term evaluation of a prospective randomized study

PURPOSE

We compared in a prospective fashion the short-term outcome of rotoresection to transurethral resection of the prostate.

MATERIALS AND METHODS

A total of 50 patients with bladder outlet obstruction secondary to benign prostatic hyperplasia were randomized into 2 groups, rotoresection and transurethral resection of the prostate. Mean+/-SD patient age was 60.76+/-5.85 years in the rotoresection and 64.24+/-6.84 in the transurethral resection groups. All patients had an International Prostate Symptom Score of 8 or more, maximum free flow rate less than 15 ml per second, prostate volume 20 to 100 ml and prostate specific antigen 1 to 4 ng/ml. Pressure flow study revealed bladder outlet obstruction (Schafer's grade 3 or more). Patients were assessed at 1, 3 and 6 months by International Prostate Symptom Score, maximum free flow rate, transrectal ultrasound, pressure flow study, hemoglobin and urinalysis.

RESULTS

At 6 months International Prostate Symptom Score decreased from 26.2+/-4.06 to 5.32+/-1.52 in the rotoresection group and from 22.84+/-4.56 to 7+/-1.4 in the transurethral resection group. Maximum free flow rate increased from 7.87+/-2.24 to 25.29+/-10.39 ml per second in the rotoresection group and from 9.44+/-2.29 to 25.2+/-5.8 ml per second in the transurethral group. Prostate volume decreased from 41.2+/-16.58 to 17.24+/-7.61 ml in the rotoresection group and from 40.6+/-16.93 to 18.28+/-8.75 ml in the transurethral group. Detrusor pressure at maximum flow and Schafer grade decreased from 79.84+/-26.8 cm H2O and 4.24+/-0.97 to 38.8+/-18.8 cm H2O and 1.24+/-0.93 in the rotoresection group, and from 63.04+/-21.08 cm H2O and 3.48+/-0.65 to 34.16+/-12.7 cm H2O and 1+/-0.7 in the transurethral group. Dilutional hyponatremia was higher with transurethral resection of the prostate (p=0.005) but no patient showed manifestations of the transurethral syndrome. Mild stress urinary incontinence was noted in 4 patients in the rotoresection group and in 3 in the transurethral group.

CONCLUSIONS

Rotoresection is a safe and effective method of treating bladder outlet obstruction resulting from benign prostatic hyperplasia, and its efficacy is comparable to transurethral resection of the prostate.

Feedback microwave thermotherapy with the ProstaLund Compact Device for obstructive benign prostatic hyperplasia: 12-month response rates and complications

PURPOSE

To evaluate the effectiveness of the ProstaLund Compact Device in the treatment of benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

A series of 38 consecutive patients with a mean age of 72.6+/-8.2 years, 19 with an indwelling catheter, underwent transurethral microwave thermotherapy (TUMT) with the ProstaLund Compact Device. Pretreatment evaluation included transrectal ultrasonography (TRUS), urodynamics, and cystoscopy for all patients and flow rate (Qmax), postvoiding residual urine volume (PVR), International Prostate Symptom Score (IPSS), and quality-of-life (QoL) assessment for those without a catheter. The mean prostate volume was 63.5+/-30 cc. The Qmax, IPSS, and QoL studies were repeated at 3, 6, and 12 months, while urodynamics, cystoscopy, and TRUS were repeated at 6 and 12 months.

RESULTS

The treatment lasted a mean of 43.1+/-17.1 minutes, achieved a maximal intraprostatic temperature of 58.7+/-7.2 degrees C, and destroyed 18.4+/-14.3 g of prostatic tissue. Twelve months post-treatment, for the patients without a catheter preoperatively, the IPSS was improved from 21.5+/-6.3 to 6.5+/-3.1 (P<0.001), Qmax from 7.2+/-3.1 mL/sec to 18.1+/-7.4 mL/sec (P<0.001), detrusor pressure at Qmax from 87.5+/-15 cm H2O to 48.4+/-16.4 cm H2O (P<0.001), and PVR from 113.2+/-78.2 mL to 34.6+/-36.7 mL (P<0.01). The good-response rates for IPSS (<or=7 or >or=50% improvement), Qmax (>or=15 mL/sec or >or=50% improvement), PVR (<50 mL or >or=50% decrease), and QoL (<or=2) were 73.7%, 84.2%, 73.7%, and 94.7%, respectively. For the patients with a catheter preoperatively, the IPSS improved from 9.5+/-6 at 3 months to 5.1+/-5.3 (P<0.05) at the end of the follow-up period. The Qmax was 13.2+/-6.4 mL/sec at 3 months and remained stable throughout the follow-up period. Patient good-response rates for IPSS (<or=7), PVR (<150 mL), and QoL (<or=2) were 75%, 87.5% and 75%, respectively. Only two patients were unable to void after the treatment. Complications were similar to those presented in the literature, and bladder stone formation was noted as well (five patients).

CONCLUSIONS

ProstaLund thermotherapy is a highly promising alternative treatment for BPH, improving substantially both objective and subjective measures of bladder outflow obstruction.

Transurethral resection vs microwave thermotherapy of the prostate: a cost-consequences analysis

OBJECTIVE

To compare the costs and outcome of high-energy transurethral microwave thermotherapy of the prostate (HE-TUMT) with transurethral resection of the prostate (TURP), as the former is considered to be the best minimally invasive method for managing lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

Between January 1996 and March 1997, 144 patients were randomized to treatment with HE-TUMT (78) using the Prostatron device and Prostasoft 2.5 software (EDAP Technomed, Lyon, France), or TURP (66). At baseline and during the annual follow-up, patients were evaluated by the International Prostate Symptom Score and uroflowmetry (maximum flow rate and postvoid residual volume). Kaplan-Meier survival analyses were used to calculate the cumulative risk of re-treatment. A cost-consequences analysis was performed based on the prospective measurement of healthcare use, with costs expressed as Netherland guilders (NLG).

RESULTS

During a 3-year follow-up period, the mean (95% confidence interval) risk of re-treatment was 22.9 (12.5-33.2)% and 13.2 (4.5-21.9)% for HE-TUMT and TURP, respectively (P = 0.215). The mean direct cost of treatment was 3450 (3444-3456) and 6560 (5992-7128) NLG for HE-TUMT and TURP, respectively. The mean total (including re-treatments), discounted (4%) 3-year cost for the HE-TUMT and TURP group was 5300 (4692-5908) and 7800 (7118-8482) NLG, respectively.

CONCLUSIONS

In this prospective randomized trial, HE-TUMT and TURP had a comparable 3-year risk of re-treatment. Healthcare expenditure on HE-TUMT, mainly because it is an outpatient treatment, was significantly lower than for TURP.

Short-term results of rotoresection for benign prostatic hyperplasia: a prospective study of safety and efficacy

OBJECTIVE

To assess the safety and efficacy of rotoresection as a method for treating benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

Thirty patients were prospectively enrolled between September 2000 and May 2001 (mean age 61 years, sd 6, range 52-78). All patients had a symptom score (AUA) of > 12, a maximum urinary flow rate (Qmax) of < 12 mL/s, a prostate of 20-80 mL and a prostate-specific antigen (PSA) level of 0-4 ng/mL. Patients with prostate or bladder cancer, a PSA level of > 10 ng/mL, previous prostate surgery, previous pelvic surgery, urethral stricture, active urinary tract infection (UTI), acute urine retention, neuropathic bladder and a serum creatinine of > 1.8 mg/mL were excluded. The adenoma was resected using the Rotoresect system (Karl Storz, Tuttlingen, Germany); the mean (sd) operative duration was 45.2 (9.9) min. The catheter was removed after 1.97 (0.3) days and patients assessed at 1, 3 and 6 months after surgery by an AUA score, Qmax, blood haemoglobin level, urine analysis and transrectal ultrasonography; all patients but two completed the follow-up.

RESULTS

At 6 months the mean (sd) AUA score decreased from 20.5 (3.8) to 1.6 (1.3), the Qmax increased from 8.7 (2) to 25.3 (12.6) mL/s, and the total prostate volume decreased from 36.5 (13) to 20.5 (7.8) mL. The mean initial haemoglobin level was 138 (10) g/L and at 1 month was 135 (12) g/L. No patient required a blood transfusion or had signs of transurethral resection syndrome. Early complications included UTI and mild stress incontinence in 10 and 11 patients, respectively. At 6 months these patients had sterile urine and were continent. Two patients had a urethral stricture and posterior urethral stone at 6 months and were treated successfully.

CONCLUSION

In the short-term, rotoresection is a safe and effective method for treating BPH; there was no significant blood loss or resection syndrome. The hospital stay was short, with excellent functional results.

Efficacy and safety of intraprostatic temperature-controlled microwave thermotherapy in patients with benign prostatic hyperplasia: results of a prospective, open-label, single-center study with 1-year follow-up

BACKGROUND AND PURPOSE

Different devices for transurethral microwave thermotherapy (TUMT) are currently available for the treatment of benign prostatic hyperplasia (BPH). We evaluated the efficacy and safety of the Prostalund Feedback Treatment (PLFT), which continuously records the intraprostatic temperature, and its impact on sexual function of the patients.

PATIENTS AND METHODS

A total of 41 patients with lower urinary tract symptoms attributed to BPH were entered in this prospective open-label, single-center study of PLFT. The initial evaluation was performed according to a standard protocol. At 3, 6, and 12 months, the International Prostate Symptom Score (IPSS), bother score, sexual function, and peak flow rate (Qmax) were recorded. In addition, determination of prostate volume by transrectal ultrasonography (TRUS) and measurement of residual urine volume were repeated at the 6- and 12-month visits. All adverse events were also recorded. Patients with IPSS of < or =7, > or =50% improvement in IPSS from baseline, a Qmax of > or =15 mL/sec, or > or =50% improvement in Qmax from baseline were judged responders to the treatment.

RESULTS

Thirty-three of the patients completed the 12-month visit. The response rate was 88% (29 of 33 patients). There was a statistically significant decrease in IPSS at the 12-month visit, the mean IPSS being 7.1 v 21.9 at baseline (P<0.001). The mean IPSS was 10.3 and 7.6 at the 3- and 6-months' follow-up, respectively. The bother score presented a similar improvement, with a decrease from a mean of 4.2 at baseline to a mean of 1.4 after 12 months (P<0.001). The mean Qmax improved from 8.4 mL/sec at baseline to 15.9 mL/sec, 19.2 mL/sec, and 17.8 mL/sec at 3, 6, and 12 months, respectively (P<0.001). The mean change in prostate volume, as determined by TRUS, was 16 mL at 6 months and 19 mL at 12 months (P<0.001). The procedure was well tolerated. The mean post-treatment catheterization time was 17.90 days. Bladder spasms and urinary tract infection were the most common adverse events. Coitus ability remained practically unchanged after treatment (from 71% to 74.3%), but the number of patients with ejaculation decreased (from 78% to 51.4%).

CONCLUSION

Our results indicate that PLFT is an effective and safe treatment for most patients with BPH.

Cooled thermotherapy for the treatment of benign prostatic hyperplasia: durability of results obtained with the Targis System

OBJECTIVES

To evaluate the durability of benefit associated with cooled high-energy thermotherapy (cooled thermotherapy) using the Targis System with data extending to 5 years after treatment.

METHODS

At three centers in Canada and the United Kingdom, 150 patients with benign prostatic hyperplasia underwent cooled thermotherapy with the Targis System. This was an outpatient procedure performed without general or regional anesthesia. Patients were followed up at 1 and 6 weeks, 3, 6, and 12 months, and yearly to 5 years.

RESULTS

Patients were evaluated at 1, 2, 3, 4, and 5 years after treatment (n = 132, 111, 90, 77, and 59, respectively). At these intervals, the American Urological Association symptom scores improved by 11.7 (57%), 12.1 (58%), 11.5 (53%), 10.1 (47%), and 10.6 (47%) points (P <0.0001 for each), the peak flow rates improved by a mean of 4.0 (57%), 4.0 (56%), 3.4 (48%), 3.3 (47%) and 2.4 (37%) mL/s (P <0.0001 for each), and quality-of-life scores improved by 2.6, 2.6, 2.5, 2.3, and 2.3 points (P <0.0001 for each). At least a 50% improvement in the American Urological Association symptom score was observed in 63% to 68% of patients available for follow-up at years 1, 2, and 3 and 50% and 51% of patients available for follow-up at years 4 and 5, respectively. Four patients required repeated microwave thermotherapy, 27 required subsequent invasive treatments, 1 permanent catheterization, 11 required alpha-blockers, and 1 antiandrogen therapy.

CONCLUSIONS

Cooled thermotherapy with the Targis System produces durable improvements in symptoms, quality of life, and flow rates to at least 5 years after treatment.

High-energy transurethral microwave thermotherapy: symptomatic vs urodynamic success

OBJECTIVE

To evaluate the subjective and objective treatment results of high-energy transurethral microwave thermotherapy (TUMT) for symptomatic benign prostatic hyperplasia (BPH), and investigate the possible variables for predicting symptomatic and/or urodynamic success.

PATIENTS AND METHODS

Between October 1998 and October 2000, 40 men with BPH underwent high-energy TUMT using the Targis device (Urologix, Inc., Minneapolis, MN, USA). Evaluation after treatment included a clinical determination of the symptom score, a urodynamic assessment by peak flow rate and pressure-flow, magnetic resonance imaging (MRI), transrectal ultrasonography and endoscopy. The objective and subjective success was correlated with several variables before, during and after treatment.

RESULTS

All patients completed at least 1 year of follow-up after TUMT as monotherapy. The symptom score improved from a median (range) of 20.5 (11-28) initially to 9 (0-28) (P < 0.001). Twenty-two patients (55%) had a marked and 11 (28%) a moderate response, giving an overall subjective success rate of 83%. Similarly, there was a significant improvement in peak flow rate, from 9.2 (4.4-13.4) to 15 (3.3-22.9) mL/s (P < 0.001). Twenty-one patients (53%) had a maximum flow rate of > 15 mL/s while in eight (20%) it was 10-15 mL/s. Only 20 patients changed from unobstructed on the pressure-flow nomogram, i.e. an overall objective success rate of 50%. Gadolinium-enhanced T1-weighted MRI 1 week after treatment showed a median (range) perfusion defect of 20.7 (5.5-76.6)% of the total gland volume. Despite this persisting in all patients, a well-defined cavity was apparent in only in seven (18%) at the final evaluation. Cystoscopy 1 month after therapy showed evidence of necrotic tissue occupying the prostatic fossa in all patients. Younger patients were more likely to be urodynamically successful, and a higher grade of obstruction predicted symptomatic success.

CONCLUSION

High-energy TUMT can induce considerable necrosis of the prostate, as shown by MRI and cystoscopy. Although there was an adequate improvement in most patients' symptoms, there was a successful urodynamic change to unobstructed in only half the patients. Younger patients and those with a higher grade of obstruction were more likely to have urodynamic and symptomatic success, respectively.

Minimally invasive therapies for benign prostatic hyperplasia

Currently, 3 categories of treatment are available for men with benign prostatic hyperplasia (BPH): (1) medicine, such as alpha-blockers and finasteride; (2) minimally invasive treatment, such as transurethral microwave thermotherapy and interstitial ablation using either radiofrequency or laser; and (3) surgical therapy. The 1990s have seen an explosion of transurethral technology to treat symptoms caused by bladder outlet obstruction secondary to BPH. Unlike surgical debulking procedures, the minimally invasive therapies attempt to treat patients without general or regional anesthesia, and even ambulatory procedures are performed in the office. Because of the demographics of patients with BPH, it is hoped that these minimally invasive options will relieve symptoms without any surgical complications and the side effects and compliance issues associated with medical therapy. It is important that urologists have a clear understanding of the clinical usefulness of these devices, so that the overall role of such treatment may be determined by science rather than marketing. Clinically, the degree of symptom score, peak flow, and quality-of-life improvement seen with all the minimally invasive techniques are similar. The techniques may differ in their ability to reach the maximum number of responders and achieve an acceptable duration of response, and the need for analgesia/sedation associated with each technique. This study will define the minimally invasive therapies and present the differences in catheter design and technique. The pathologic basis for these therapeutic options and the advantages and disadvantages of each will be discussed. Urologists must decide which therapy can be used in their office practice. The maximum numbers of responders and enhanced durability of the treatment can be achieved based on realistic expectations, proper selection of patients, and complete information on the potential of these devices.

The relationship of the International Prostate Symptom Score and objective parameters for diagnosing bladder outlet obstruction. Part I: when statistics fail

PURPOSE

We evaluated the International Prostate Symptom Score and correlated it with objective means of determining bladder outlet obstruction.

MATERIALS AND METHODS

Beginning in May 1996, 460 men 41 to 88 years old (mean age plus or minus standard deviation 60.4 +/- 9.4) were prospectively included in this study. Symptoms were evaluated using the International Prostate Symptom Score, and digital rectal examination, outpatient cystoscopy, prostate specific antigen determination and transrectal ultrasound were done. Urodynamic evaluation included uroflowmetry, filling cystometry and pressure flow study.

RESULTS

Linear regression was done to correlate scores with measurable parameters. We noted no correlation of the total, obstructive symptoms or irritative symptoms score with objective parameters, including the average and maximum flow rate, post-void residual urine, prostate size and Schäfer grade.

CONCLUSIONS

Prostatic symptom scores are qualitative. Using them to quantify the degree of obstruction or evaluate therapy is questionable.

Transurethral radiofrequency thermal ablation of prostatic tissue: a feasibility study in humans

OBJECTIVES

To evaluate the feasibility and efficacy of ablating prostatic tissue by inducing thermal lesions using radiofrequency (RF) energy delivered transurethrally through electrodes mounted on a Foley-like catheter.

METHODS

Twenty male patients, candidates for radical cystoprostatectomy to treat bladder carcinoma, underwent RF prostate ablation 1 to 8 days before surgery (mean 2.8). Stainless steel, internally cooled, 2-cm-long electrodes mounted on a Foley-like catheter were used to deliver RF energy to the prostatic tissue. Semicircular electrodes were used in 10 patients (group A) and circular electrodes were used in the remaining 10 patients (group B). The urethral, rectal, and prostatic tissue temperatures were recorded. Histologic step sections were performed on whole mounts of the prostates to define the volume of the thermal lesions.

RESULTS

The mean RF energy delivered was 36.5 kJ (range 26.4 to 53.1) in group A and 82.3 kJ (range 38 to 149) in group B. The intraprostatic temperatures were between 44 degrees C and 80 degrees C in group A and between 60 degrees C and 119 degrees C in group B. The urethral and rectal temperatures never exceeded 42 degrees C. No major complications occurred. After the RF procedure, 5 patients who received more than 75 kJ of energy could not void and required catheterization. The mean prostate volume was 11.54 cm(3) for group A and 24.02 cm(3) for group B. The mean volumes of the thermal lesions and their relative percentages in relation to the whole prostate in groups A and B were, respectively, 1.69 cm(3) and 15% and 6.91 cm(3) and 29% (P = 0.049). Analysis of variance showed a significant correlation between the thermal lesion volume and the energy delivered, regardless of the electrode shape (P = 0.001).

CONCLUSIONS

Satisfactory thermal ablation of prostatic tissue can be achieved using RF electrodes mounted on a Foley-like catheter. The procedure is effective, simple, and safe and, therefore, can be used in pilot clinical studies on patients with benign prostatic hyperplasia.

Heat treatment of the prostate: where do we stand in 2000?

Various minimally invasive modalities that are aimed at alleviating lower urinary tract symptoms employ heat-induced ablation of hyperplastic prostatic tissue. Following extensive studies, most of these modalities were eventually abandoned. High-energy transurethral microwave thermotherapy has survived, however, and has gained a firm position as a therapeutic modality, along with transurethral resection of the prostate. Recent research addressed fundamental issues of mode of action of microwave treatment, and revealed the overall efficacy of this treatment, determined new indications, and rendered high-energy transurethral microwave thermotherapy more acceptable to the patients. Insights into intraprostatic vascularization and treatment monitoring were also gained as a result of these global research efforts.

Transurethral microwave thermotherapy: an alternative to medical management in patients with benign prostatic hyperplasia?

Transurethral microwave thermotherapy (TUMT) is being increasingly considered as an alternative to medical management with alpha-blockers or finasteride in patients with lower urinary tract symptoms (LUTS) of benign prostate hyperplasia (BPH). Enduring clinical benefits have been demonstrated after a single 1-hour microwave treatment session under topical anesthesia, and the associated morbidity is low. Optimal results are obtained with the delivery of high thermal doses and accurate targeting of microwave energy. Extensive evidence from randomized clinical trials supports the safety and efficacy of both microwave treatment and medical management, but randomized trial data have only recently become available directly comparing these two approaches to BPH treatment. These data indicate that greater long-term improvements in symptoms, peak urinary flow rates, and quality of life are attained with microwave treatment than with alpha-blockade. Furthermore, the actuarial rate of treatment failure is markedly lower in patients undergoing microwave v alpha-blocker treatment. However, the onset of action of alpha-blocker treatment is more rapid. The principal limitations of alpha-blockade are side effects and lack of efficacy leading to treatment failure in some patients. The maximal effects of finasteride are modest and require a period of months to be manifested, although the side effect profile and tolerability of this agent are favorable. Neoadjuvant and adjuvant alpha-blocker therapy can accelerate symptom and flow rate improvement after TUMT. In contrast to medical management, microwave treatment is highly versatile, allowing patients over a broad range of baseline symptom severities and prostate sizes to be treated with a high probability of success.

Transurethral microwave thermotherapy: symptom relief v urodynamic changes

Transurethral microwave thermotherapy (TUMT), whether in its low- or high-energy form, seems to reduce the symptoms of benign prostatic hyperplasia, with low-energy treatment resulting in less improvement than high-energy treatment. Low-energy TUMT has a minimal effect on bladder outlet obstruction, as judged by urodynamic findings, and may not be suitable to treat those patients with significant obstruction. High-energy TUMT does seem to relieve obstruction significantly, although it is not as effective as TURP. Urodynamic studies may provide the answer as to which therapy to offer the patient.