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Transurethral microwave therapy for BPH

 

Clinical bottom line

Transurethral microwave therapy for BPH appears to be effective and the benefits appear to be of long duration.


References

B Djavan & M Marberger. Transurethral microwave thermotherapy: an alternative to medical management in patients with benign prostatic hyperplasia? Journal of Endourology 2000 14: 661-669.

EW Ransey & C Dahlstrand. Duration of results obtained with transurethral microwave thermotherapy in the treatment of men with symptomatic benign prostatic hyperplasia? Journal of Endourology 2000 14: 671-675.

Review

Neither of these reviews gives a search strategy or any great detail about the studies included. This makes the applicability of the results questionable. The implication of the first review is that it examines randomised studies comparing transurethral microwave therapy with sham therapy. The second review says that it described studies with at least three years of follow up.

Results

The first review gave percentage changes for symptoms and maximum urinary flow rates at three months after operation. The results for the percentage change in maximum urinary flow rate are shown in Figure 1. Of eight trials with 43 to 220 men, seven had a significant benefit for actual over sham treatment for symptom decrease (by 40% to 70%). For increase in maximum urinary flow rate six had significant increases in maximum urinary flow rate (by 14% to 58%).

Figure 1: Percentage change in maximum urinary flow rate at three months with tansurethral microwave therapy and sham therapy

Eleven studies had information on men after tansurethral microwave therapy followed up for three to seven years, and with between 38 and 1,092 men. Improvements in symptom scores, maximum flow rate, and quality of life seemed to be maintained up to seven years. For maximum urinary flow rates, improvements were generally over 10 mL/second in men with mean baseline flow rates of 8-10 mL/second.

The need for additional surgery, repeat microwave therapy and drugs is also given, and it appears that about half of the men need some additional treatment at some time. Differences in surgical technique (such as power of the microwave unit), duration of follow up, and local preference make this difficult to interpret.

Comment

These are useful reviews as far as they go, but they are not easy to read or interpret. It's a good place to start when evaluating this therapy, though.