The impact of transurethral microwave thermotherapy on erectile function and lower urinary tract symptoms in men with benign prostatic hyperplasia – short communication

Abstract

Abstract Introduction: Although microwave thermotherapy is becoming an almost forgotten therapy, occasional reports confirm that transurethral microwave thermotherapy (TUMT) still seems to be a good alternative for benign prostate hyperplasia (BPH). The aim of this study was to re-evaluate the advantages and disadvantages of TUMT. Materials and methods: The non-randomized study included 4590 patients with BPH. All patients were on pharmacological treatment. Prior to the study, patients underwent digital rectal examination (DRE), ultrasound examination, uro-dynamic examination, and prostatic specific antigen (PSA) concentration. Exclusion criteria included suspected prostate cancer on DRE, an ambiguous result of the urodynamic examination, suggesting a neurological component in lower urinary tract symptoms (LUTS), and elevated PSA concentration. In the end, 3329 patients were enrolled for further analysis. Of this group 2159 patients elected to receive TUMT. The others decided to continue their pharmacotherapy. Two questionnaires were used to evaluate the effect of TUMT on the relief of urinary symptoms and erectile dysfunction (ED). The International Prostate Symptom Score (IPSS) was used for LUTS and the International Index of Erectile Function-5 (IIEF-5) for ED. Results: After 6 months from thermotherapy, more than 50% of patients experienced an improvement in their urination (p < 0.0018), while in the pharmacological group only 30% did (p < 0.031). Approximately 28% of all patients regained erection. Before thermotherapy, only 12% reported no erection problems. In contrast, a further deterioration of erectile function (EF) was observed in the reference group (differences with TUMT at p < 0.0001). Apart from transient fever or temporary urinary retention, no serious complications were observed. Conclusions: It appears that TUMT is still a valuable option for BPH, especially in outpatient practice and for those patients who wish to protect their EF.