Microwave thermotherapy for benign prostatic hyperplasia
Abstract
Background
Transurethral resection of the prostate (TURP) has been the gold‐standard treatment for alleviating urinary symptoms and improving urinary flow in men with symptomatic benign prostatic hyperplasia (BPH). However, the morbidity of TURP approaches 20%, and less invasive techniques have been developed for treating BPH. Preliminary data suggest that microwave thermotherapy, which delivers microwave energy to produce coagulation necrosis in prostatic tissue, is a safe, effective treatment for BPH.
Objectives
To assess the therapeutic efficacy and safety of microwave thermotherapy techniques for treating men with symptomatic benign prostatic obstruction.
Search methods
Randomized controlled trials were identified from The Cochrane Library, MEDLINE, EMBASE, bibliographies of retrieved articles, reviews, technical reports, and by contacting relevant expert trialists and microwave manufacturers.
Selection criteria
All randomized controlled trials evaluating transurethral microwave thermotherapy (TUMT) for men with symptomatic BPH were eligible for this review. Comparison groups could include transurethral resection of the prostate, minimally invasive prostatectomy techniques, sham thermotherapy procedures, and medications. Outcome measures included urinary symptoms, urinary function, prostate volume, mortality, morbidity, and retreatment. Two review authors independently identified potentially relevant abstracts and then assessed the full papers for inclusion.
Data collection and analysis
Two review authors independently abstracted study design, baseline characteristics, and outcomes data and assessed methodological quality using a standard form. We attempted to obtain missing data from authors or sponsors, or both.
Main results
In this update, we identified no new randomized comparisons of TUMT that provided evaluable effectiveness data. Fifteen studies involving 1585 patients met the inclusion criteria, including six comparisons of microwave thermotherapy with TURP, eight comparisons with sham thermotherapy procedures, and one comparison with an alpha‐blocker. Study durations ranged from 3 to 60 months. The mean age of participants was 66.8 years and the baseline symptom scores and urinary flow rates, which did not differ across treatment groups, demonstrated moderately severe lower urinary tract symptoms. The pooled mean urinary symptom scores decreased by 65% with TUMT and by 77% with TURP. The weighted mean difference (WMD) with 95% confidence interval (CI) for the International Prostate Symptom Score (IPSS) was ‐1.00 (95% CI ‐2.03 to ‐0.03), favoring TURP. The pooled mean peak urinary flow increased by 70% with TUMT and by 119% with TURP. The WMD for peak urinary flow was 5.08 mL/s (95% CI 3.88 to 6.28 mL/s), favoring TURP. Compared to TURP, TUMT was associated with decreased risks for retrograde ejaculation, treatment for strictures, hematuria, blood transfusions, and the transurethral resection syndrome, but increased risks for dysuria, urinary retention, and retreatment for BPH symptoms. Microwave thermotherapy improved IPSS symptom scores (WMD ‐5.15, 95% CI ‐4.26 to ‐6.04) and peak urinary flow (WMD 2.01 mL/s, 95% CI 0.85 to 3.16) compared with sham procedures. Microwave thermotherapy also improved IPSS symptom scores (WMD ‐4.20, 95% CI ‐3.15 to ‐5.25) and peak urinary flow (WMD 2.30 mL/s, 95% CI 1.47 to 3.13) in the one comparison with alpha‐blockers. No studies evaluated the effects of symptom duration, patient characteristics, prostate‐specific antigen levels, or prostate volume on treatment response.
Authors' conclusions
Microwave thermotherapy techniques are effective alternatives to TURP and alpha‐blockers for treating symptomatic BPH in men with no history of urinary retention or previous prostate procedures and prostate volumes between 30 to 100 mL. However, TURP provided greater symptom score and urinary flow improvements and reduced the need for subsequent BPH treatments compared to TUMT. Small sample sizes and differences in study design limit comparisons between devices with different designs and energy levels. The effects of symptom duration, patient characteristics, or prostate volume on treatment response are unknown.
PICOs
Plain language summary
Microwave thermotherapy is an effective treatment to relieve urinary symptoms and urinary flow problems caused by an enlarged prostate gland
Benign prostatic hyperplasia may lead to troublesome urinary symptoms, particularly in older men. Transurethral resection of the prostate (TURP) has been considered the definitive treatment for BPH. However, TURP is associated with complications. Therefore, less invasive techniques have been developed. These include microwave thermotherapy, which applies energy (heat) to shrink enlarged prostatic tissue. We found microwave thermotherapy to be a relatively safe and effective treatment option. Microwave thermotherapy can be performed as an outpatient procedure and has fewer and less severe side effects than TURP. However, TURP produced greater improvements in urinary symptoms and urine flow and fewer men required retreatment. Further studies are needed to determine the long‐term outcomes of microwave thermotherapy and to identify the most effective microwave thermotherapy devices and energy settings.
