Transrectal Prostatic Hyperthermia and Urinary Retention Secondary to Benign Prostatic Hyperplasia: A 2-Year Follow-Up Study

Microwave thermotherapy: historical overview

The application of heat with curative aim is an old and very well-known principle in medicine. A review of the history of heat use in the treatment of prostatic disease is presented. The article is based on bibliographic research (MEDLINE Search and PubMed) and focuses on treatment of benign prostatic hyperplasia (BPH) since the first clinical documentation of transrectal hyperthermia for this condition. Then, in a chronological sequence, not only the evolution toward thermotherapy but also enhancements of the latest techniques are presented. The new advances in the field of patient selection, indications, and outcome predictors, as well as new trends in treatment are briefly considered.

Transurethral thermotherapy in the management of benign prostatic hyperplasia

Transurethral radiofrequency thermotherapy for symptomatic benign prostatic hyperplasia was performed in 50 selected patients, using the THERMEX II device. High surgical risk patients were included, among them 13 previously catheterized ones, because of unresolved retention for more than 6 months. The treatment consisted of a three-hour single session at 47 degrees C. Follow-up studies were carried out at 1, 3, 6 and 12 months using Madsen score, maximum flow rate, residual urine volume determinations and prostate bulk measurement by transrectal ultrasound. Subjective and objective improvement (of more than two parameters) was noticed in 62% of the patients. Prostatic volume did not change. In the retention group 54% of the patients remained free of catheter. Postoperative histology in 8 cases that failed to respond, revealed focal haemorrhagic and necrotic changes in periurethral glandular tissue. This is a promising method for selected high risk patients that achieves reasonable but not comparable results to TURP and requires further investigation in larger patient groups with BPH.

Is there a role for transrectal microwave hyperthermia in the treatment of benign prostatic hyperplasia? A critical review of a six-year experience

We critically reviewed our 6-year experience with transrectal microwave hyperthermia of the prostate for benign prostatic hyperplasia (BPH) in 320 patients either at high surgical risk or refusing surgery. Transrectal prostatic hyperthermia was given in five to ten 60-minute sessions with an intraprostatic temperature ranging from 42 degrees to 43.5 degrees C. Although an amelioration of symptoms and urodynamic measures was seen initially in most patients, only residual urine volume showed a statistically and clinically significant improvement at the long-term follow-up. According to maximum flow nomograms, bladder outlet obstruction was not resolved by the treatment. We conclude that although the transrectal hyperthermia proved to be a safe procedure, it did not cure BPH in the long term. Considering the results seen with newer nonsurgical procedures such as prostatic stents and prostatic lasers, we believe that transrectal hyperthermia should not be recommended to symptomatic BPH patients.