Transurethral microwave thermotherapy for treatment of benign prostatic hyperplasia: a preliminary assessment of the Prostalund feedback treatment machine.

OBJECTIVE: The aim of this preliminary study was to evaluate the efficacy of Prostalund feedback treatment (PLFT) using microwave thermotherapy equipment for benign prostate hyperplasia (BPH) in patients with urinary retention and an indwelling urethral catheter.

SUBJECTS AND METHODS: Four unselected patients, 51-68 years old (mean age 60 years), with urinary retention and an indwelling catheter were treated with PLFT under local anaesthesia and sedation. They were considered high-risk patients for treatment by transurethral resection of the prostate (TURP) under spinal or general anaesthesia. Initial assessment included prostate-specific antigen, determination of prostate volume and exclusion of prostate cancer using transrectal ultrasound (TRUS). The patients had the indwelling catheter for 1-2 weeks prior to treatment, the urethral catheters were removed 10-12 days after PLFT. Two patients who failed to void after transurethral microwave thermotherapy underwent urodynamic study to determine the reason for failure.

RESULT: The mean volume of the treated prostate gland was 75.50 cm3 (range 51-150 cm3). Two of the 4 patients were successfully relieved of their indwelling catheter with satisfactory peak flow, residual urine and symptom score, while treatment failed in the remaining 2. The reasons for the failure were identified as a small bladder capacity and neurogenic bladder in a diabetic patient and the presence of a middle lobe with large protruding lateral lobes into the bladder of the other patient. The latter patient had a prostate volume of 150 cm3. 'Salvage' TURP in both patients revealed that PLFT caused extensive necrosis of prostatic tissue and the TURP was then accomplished with minimal blood loss (<200 ml) even in the patient with 150-gram prostate. There were no serious complications such as bleeding, sepsis, rectoprostatic fistula or urine incontinence.

CONCLUSION: The result of this preliminary investigation appears to be satisfactory and indicates that PLFT could be a good, minimally invasive alternative to surgery for BPH patients with retention of urine and an indwelling catheter.