Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia.

OBJECTIVE: To compare the efficacy and frequency of complications of transurethral interstitial laser coagulation (ILC) and transurethral microwave thermotherapy (TUMT) with transurethral resection or incision of the prostate (TURP/TUIP) in patients with symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Forty-eight patients were randomized to undergo ILC, 46 to TUMT and 24 to TURP/TUIP; they were followed for 6 months and the outcome analysed on an intention-to-treat basis. RESULTS: At 6 months the symptom scores and maximum urinary flow rate (Qmax) had improved significantly in all groups. At 6 months the mean symptom score was 9.2 in both experimental groups and 6.8 in the control group (P > 0.05); the mean Qmax was 20.6 mL/s in the control group, 16.2 in the ILC group (P > 0.05 vs control) and 13.2 in the TUMT group (P < 0.05 vs. the control group). In the TUMT group patients developing urinary retention afterward had a significantly greater increase in Qmax than those who did not. The types of complications in the three groups varied. Urinary tract infection occurred frequently in the experimental groups, especially after ILC, whereas the 'well-known' complications of TURP occurred in the control group. Overall, 36% in the ILC, 54% in the TUMT and 73% in the control group had no complications (retrograde ejaculation excluded) during the first 6 months. One patient in the TUMT group underwent TURP after 3 months, whereas no patients in the ILC or the con-trol group were re-treated for BPH within the first 6 months. CONCLUSION: In the short term both ILC and TUMT are reasonable alternatives to standard transurethral surgery for symptomatic BPH, where the reduction of symptoms is the primary goal of treatment. However, both ILC and TUMT were associated with morbidity, although the complication profiles differed from those after TURP/TUIP. Both ILC and TUMT seem advantageous in some patients because of the reduced risk of bleeding and the eliminated risk of TUR syndrome, and because TUMT only requires local anaesthesia. Thus, as neither treatment is better in all aspects, the advantages of one technique over the other must be weighed when deciding how to treat each patient.

Cost-effectiveness of new treatments for benign prostatic hyperplasia: results of a randomized trial comparing the short-term cost-effectiveness of transurethral interstitial laser coagulation of the prostate, transurethral microwave thermotherapy and standard transurethral resection or incision of the prostate.

OBJECTIVES: To compare the short-term cost-effectiveness of ILC and TUMT with that of transurethral resection or incision of the prostate in patients with symptomatic benign prostatic hyperplasia. MATERIAL AND METHODS: One hundred and eighteen patients were randomized to ILC, TUMT and TUR-P/TUI-P in 2:2:1 fashion. The use of resources within the first 6 months of follow-up were measured and the cost of treatment for each patient were calculated. A few parameters, primarily related to the time spent by the staff, were measured only in a subgroup of patients. A cost-effectiveness analysis was performed based on the average calculated cost and change in I-PSS found in each group. For costly resources a sensitivity analysis was performed. RESULTS: At 6 months the cost was lowest in the TUMT group and highest in the ILC group. The cost-effectiveness ratio (C/E) was 763 DKK/point reduction in I-PSS in the control group and 1.200 and 938 in the ILC and TUMT group, respectively. An incremental analysis demonstrated that TUR-P/TUI-P dominated ILC. In a similar comparison of the TUMT and the TUR-P/TUI-P group an incremental ratio of 170 DKK/extra point of reduction in I-PSS was found in the TUR-P/TUI-P group. CONCLUSION: In the short-term TUMT and TUR-P has comparable cost-effectiveness. TUR-P was slightly more effective than TUMT, but the cost was also slightly higher. In our set-up of ILC the short-term cost-effectiveness of ILC was inferior to that of TUR-P. Conclusions should be made with caution, since the follow-up at present is short.

[Transurethral microwave thermotherapy. A therapeutic option for high-risk patients with urinary retention secondary to benign prostatic hyperplasia]. / Transuretral mikrobølgetermoterapi. En behandlingsmulighed hos højrisikopatienter med urinretention sekundaert til benign prostatahyperplasi.

Urinary retention secondary to benign prostatic hyperplasia is considered an absolute indication for surgical treatment of the prostate. Transurethral resection of the prostate is still considered the gold standard in terms of effectiveness. One of several new techniques for treatment of BPH is transurethral microwave thermotherapy (TUMT). Our first experiences with this technique in a group of patients with urinary retention were analysed retrospectively. In the short term 16 of the 25 treated patients were able to void spontaneously with acceptable bladder emptying (64%, 95% CI: 43-85). Later on, three of these initial successes received further treatments for BPH, two had a transurethral resection of the prostate and one was given medical therapy. No serious complication was seen except in one patient who developed a urethrorectal fistula which healed following conservative treatment. The success rate following TUMT was inferior to that of standard transurethral resection, but TUMT seems an acceptable alternative in patients with pronounced co-morbidity.

[Transurethral treatment of seminal vesicle abscess]. / Transuretral behandling af vesicula seminalis-absces.

An 83-year old male with a seminal vesicle abscess is presented. Initially, cancer of the prostate was suspected and the findings of the transrectal ultrasound scan were misinterpreted. The diagnosis was made by CT-scan. When drainage failed the patient was treated successfully with transurethral unroofing.

Ureteropyeloscopic tumour treatment.

Ureteropyeloscopy was used to follow-up two patients with upper urinary tract transitional cell tumours treated by topical chemotherapy. Epodyl was instilled into the pelvis and ureter through a ureteric catheter. There were no complications. The ureteric tumours responded completely, whereas a pelvic papilloma diminished in size to about 1 mm.

Ureterorenoscopy. Results of diagnostic and therapeutic procedures.

During a 32-month period, 215 ureterorenoscopies were attempted in 171 ureterorenal units. The success rates for stone retrieval were 87% in the lower third of the ureter, 67% in the middle third, 75% in the upper third, and 55% in the pelvis. In 18% of cases a particular lesion could not be reached in diagnostic endoscopy but biopsies were obtained from seven out of eight tumours. The ureteric orifice was never dilated beyond 8 F and, yet, only four times could the instrument not be passed into the ureter. One major complication, an avulsion of 12 cm of the distal ureter, occurred. It is concluded that ureterorenoscopy is of significant value in the diagnosis and treatment of ureteric diseases.