MICROWAVE THERAPY FOR BPH
Walter M. O'Brien, M.D., Urologist

The prostate enlarges in all men - an inevitable consequence of aging. As the prostate enlarges, it compresses the urethra and causes difficulty with urination in one out of four men. When treatment is required, there are a variety of choices available. For many men, drug therapy provides excellent treatment. However, for some men, ongoing treatment with medication is not the answer. Some men have bothersome side effects related to the pills they take for the enlarged prostate. Proscar and Avodart, pills which reduce the size of the enlarged prostate, can cause erectile dysfunction in a subset of men. The alpha blockers - Hytrin, Cardura, Flomax and Uroxatrol - work by relieving the grip of the prostate as it compresses the urethra. Possible side effects include dizziness, lightheadedness, nasal stuffiness, and retrograde ejaculation (retrograde ejaculation describes the circumstance where a man has orgasm but the ejaculated fluid flows back into the bladder rather than out through the tip of the penis). In addition to these potential side effects, another drawback to drug therapy for some men may be cost. Estimates for the annual cost of brand name drug therapy range from $300 to $1,500 annually.

In our Benign Prostatic Hyperplasia newsletter, indications for BPH treatment are noted and include urinary retention, large postvoid residual which can interfere with kidney function, bleeding, recurrent urinary infection, and bothersome voiding symptoms. When pills are not working or when they cause side effects, transurethral microwave therapy (TUMT) is one of the treatment options available. TUMT uses heat to coagulate the enlarged portion of the prostate which in turn leads to a reduction in prostate size over the course of the next 3-6 months. When compared to laser treatment of the prostate or transurethral resection of the prostate (the surgical removal of the enlarged portion of the prostate), TUMT is an outpatient office-based procedure that does not require general anesthesia.

Prior to TUMT, transrectal ultrasound of the prostate may be done to evaluate the size and the shape of the prostate to plan for treatment. Transrectal ultrasound is an office-based procedure carried out by placing a small ultrasound probe into the rectal area which then allows imaging of the prostate to measure prostate volume and length.

The TUMT procedure is done in the office. Patients may initially be pre-medicated with Valium to make them more comfortable during the procedure. Xylocaine jelly (no needle or injection) is placed into the urethra, the urinary channel in the penis. A specialized catheter placed into the urethra delivers the microwave energy to the enlarged portion of the prostate. The treatment period typically lasts around 60 minutes. Patients may feel a sense of heat in the lower abdomen and pelvic area during treatment. They may also have "bladder spasm," in which they feel the sense of the need to urinate in association with mild cramping in the lower abdomen. After treatment is complete, the microwave catheter is removed and a new urinary catheter is placed to drain urine from the bladder over the course of the next several days. If the patient has received Valium, then he needs someone else to drive him home.

After treatment, patients may experience frequency (the need to urinate more often), urgency (the sense of the need to urinate as soon as the urge is felt), and pain or discomfort with urination. There may also be blood in the urine or the semen on an intermittent basis over the next 4-6 weeks. At first, urination may be more bothersome than it was prior to the procedure, but improvement in urinary pattern typically develops over time as the coagulated portion of the prostate treated with the microwave reduces in size. Studies indicate that three of four men treated with microwave therapy experience symptom relief. TUMT typically does not cause sexual side effects, such as erectile dysfunction or retrograde ejaculation. In addition, TUMT does not interfere with other types of prostate treatment, so that if TUMT does not provide benefit, one of the other treatment options may still be carried out.

In summary, microwave treatment of the prostate, an office-based procedure that does not require regional or general anesthesia, provides improvement in three out of four men, typically without adverse effects on sexual function, and allows men the option of not having to take a pill on an ongoing daily basis.