Transurethral microwave thermotherapy (TUMT) is a procedure that is used to treat the symptoms of benign prostatic hyperplasia (BPH), a condition in which the prostate gland in men becomes enlarged. Because the gland surrounds the urethra (the tube that connects the bladder to the genitals), its enlargement can compress the tube and obstruct urinary flow, making it difficult and, at times, painful to urinate. In severe cases, urination may not occur at all. TUMT uses microwave radiation to destroy some of the prostate tissue without the need for incisions.
How is Transurethral Microwave Thermotherapy Performed?
During TUMT, a special tube (catheter) is inserted into the urethra--which travels through the penis--and advanced up toward the bladder. The prostate surrounds the urethra near where it exits the bladder.
A special antenna is inserted into the catheter until it is adjacent to the prostate. Microwave radiation given off by the antenna heats and destroys the prostate tissue.
Destroying part of the prostate relieves the lower urinary tract symptoms that occur with BPH, such as:
- Nighttime urination
- Frequent, urgent, or painful urination
- Weak or hesitant stream of urine
- Incomplete emptying of the bladder
TUMT may also work for other conditions of the prostate, such as chronic prostatitis (inflammation of the prostate), although it is mainly used as a treatment for BPH.
Who is Transurethral Microwave Thermotherapy Best Suited for?
TUMT works best for men with BPH who:
- Have moderate to severe problems with urination (urinary incontinence)
- Experience side effects from medical therapy
- Tried medical therapy but it failed
- Do not want to be treated medically
Men with any of the following may not be eligible for TUMT, as determined by the doctor:
- Active urinary tract infections
- Previous history of surgery on or trauma to the prostate
- Too small of a prostate
- Implants in or around the penis, urethra, or bladder that may interfere with the microwave radiation
What Tests are Needed Prior to TUMT?
Before transurethral microwave thermotherapy is performed, a doctor may carry out any of the following to make sure the procedure is appropriate:
- Medical history and physical examination
- Blood tests, such as complete blood counts and blood chemistries, to check general health
- Prostate-specific antigen (PSA) test, done with a blood sample, to check for risk of prostate cancer
- Urine tests to look for signs of a urinary tract infection
- Transrectal ultrasonography, an imaging test using sound waves to look at the prostate
- Renal ultrasonography, an imaging test used to check the health of the kidneys, which can be damaged due to BPH if urine is completely hampered and builds up in the bean-shaped organs.
- Tests to determine the speed of urination or to determine how much urine remains in the bladder at the end of urination
- Cystourethroscopy, a test in which a tiny camera is inserted in the urethra to examine the bladder and urethra
What to Expect During TUMT?
Prior to transurethral microwave therapy, patients are given oral antibiotics to prevent infections. They may also receive other medicines, such as pain killers or anti-anxiety drugs. The penis is cleaned and the urethra is numbed with an anesthetic gel. A tube is then inserted into the urethra until it is in place alongside the prostate. Sometimes a probe is inserted into the rectum to measure temperature throughout the procedure.
What are the Risks of TUMT?
As with any medical procedure, there are certain risks associated with transurethral microwave therapy, such as:
- Inability to completely empty the bladder
- Urinary tract infection
- Pain in the belly or groin
- Backwards ejaculation
- Erectile dysfunction
- Increased risk of heart attack within 2 years of treatment
- Damage to the urethra, bladder, or tissues surrounding the prostate
Prognosis Following TUMT
In one study, TUMT resulted in a greater relief of symptoms after 6 months, when compared to sham treatment (inserting the catheter, but not turning on the microwave antenna). Some patients had improved symptoms after 24 months. The size of the prostate also decreased in 77 percent of patients. Other studies have shown that the outcome of TUMT is similar to another method for treating BPH, transurethral resection of the prostate (TURP). Men treated with TURP had fewer symptoms and higher flow of urine than those treated with TUMT. The risks of TURP, however, were greater both in the short- and long-term.
Arai Y, Aoki Y, Okubo K, et al. (2000). Impact of interventional therapy for benign prostatic hyperplasia on quality of life and sexual function: a prospective study. J Urol 164(4):1206-11.
de la Rosette JJ, Francisca EA, Kortmann BB, et al. (2000). Clinical efficacy of a new 30-min algorithm for transurethral microwave thermotherapy: initial results. BJU Int 86(1):47-51.
Francisca EA, d'Ancona FC, Hendriks JC, et al. (1997). Quality of life assessment in patients treated with lower energy thermotherapy (Prostasoft 2.0): results of a randomized transurethral microwave thermotherapy versus sham study. J Urol 158(5):1839-44.
Ahmed M, Bell T, Lawrence WT, et al. (1997). Transurethral microwave thermotherapy (Prostatron version 2.5) compared with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a randomized, controlled, parallel study. Br J Urol 79(2):181-185.