Transurethral microwave thermotherapy versus transurethral resection of prostate.

PURPOSE: Invasiveness, delayed morbidity, and the high cost of transurethral resection of the prostate (TURP) have resulted in the proposal of transurethral microwave thermotherapy (TUMT) as an alternative and less invasive treatment.

METHODS: Only a few randomized studies have evaluated the functional results of TUMT vs. TURP. Despite restricted inclusion criteria, they all concluded that TUMT is as effective as TURP in relieving subjective symptoms, but that it generally leads to less improvement in objective symptoms.

RESULTS: TUMT results seem to last at least 36 months; at 1-year follow-up, the rate of repeat treatment is 3.2%. The rates of morbidity in both groups are roughly in the same range. Acute urinary retention (10-13.5%) and postoperative voiding discomfort are the main occurrences after TUMT; bleeding, retrograde ejaculation (50-80%), and urethral strictures (3.1-6.6%) occur after TURP. Cost evaluation, related only to Targis and U.S. data, favors TUMT. However, it seems likely that the overall cost of TUMT procedures may decrease if TUMT becomes a widely used technique, including fair reimbursement from private insurance companies or from social security departments in European countries. TUMT is safe and effective to treat BPH.

CONCLUSIONS: Nevertheless, to date, the improvement that occurs in most variables seems to be less than that after TURP.