High-energy transurethral microwave thermotherapy for large severely obstructing prostates and the use of biodegradable stents to avoid catheterization after treatment.

OBJECTIVE: To assess the use of high-energy transurethral microwave thermotherapy (TUMT) for large severely obstructing benign prostatic hyperplasia (BPH) and to compare the use of a biodegradable stent with that of a urethral Foley catheter after TUMT. PATIENTS AND METHODS: The study comprised 30 men (mean age 71 years, range 49-82) scheduled for prostatectomy for symptomatic BPH. Pre-operative investigations included the measurement of urinary free flow rate, residual urine volume (ultrasonographically), a digital rectal examination, transrectal ultrasonography, a symptom score, cystoscopy, cystometry and pressure-flow. The obstruction was graded according to the Schäfer nomogram. The patients were treated using the Prostatron (EDAP-Technorned, France) TUMT system; the software used provided a maximum power of 70 W. Patients were catheterised after treatment with either a Foley catheter or a biodegradable stent. After 3 months, the measurements and obstruction grading were repeated, and the effect of the stent assessed.
RESULTS: In the entire group, the mean (SD) free flow increased from 7.7 (2.4) to 14.0 (3.3) mL/s, the residual urine decreased from 125 (86) to 23 (25) mL and the symptom score decreased from 16 (8) to 5 (4). The mean (SD) degree of obstruction decreased from 81.0 (16) to 62.6 (15). The biodegradable stent completely avoided post-treatment retention.
CONCLUSION: High-energy TUMT can be used on large severely obstructing prostates with major subjective and objective improvements. The biodegradable stent is useful in relieving the problems of catheterization after treatment.