Microwave thermotherapy: a long-term follow-up of 67 patients from a single centre.

OBJECTIVE: To determine the long-term therapeutic value of transurethral microwave thermotherapy (TUMT) in the treatment of bladder outflow obstruction secondary to benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: A total of 67 patients with BPH, assessed using symptom scores and measurements of urinary flow rate, underwent TUMT using the Leo Microthermer system (Laser Electro Optics Ltd, London, UK) between October 1990 and June 1992. Follow-up information was obtained on 60 patients (90%). If they had undergone no further treatment for their BPH, they were re-assessed with symptom scores and measurements of flow rate. RESULTS: The mean follow-up was 52.4 months; eight of the 6 7 patients had died and seven were lost to follow-up. Sixteen of the remaining 52 (31%) had undergone another treatment for BPH; one patient developed prostatitis and one developed localized carcinoma of the prostate. Thirty-four patients had had no further treatment, 29 of whom attended for assessment. In these patients, a statistically significant improvement in both the symptom score and flow rate was maintained at 4 years. No patients developed retrograde ejaculation. CONCLUSION: This is the first study to report a follow-up of at least 4 years after TUMT with any device. Treatment with the Leo Microthermer provided at least a 50% symptomatic improvement in 16 of 50 patients treated at 4 years. However, 30% of the patients needed further treatment for their BPH. TUMT is safe and effective in patients not wanting anaesthesia and in young patients concerned about retrograde ejaculation.

Radioligand-binding analysis of human prostatic alpha-1 adrenoreceptor density following transurethral microwave therapy.

OBJECTIVE: To determine the effects of single-session transurethral microwave treatment (TUMT) on human prostatic alpha-1 adrenoreceptor density in patients with symptomatic bladder outlet obstruction caused by benign prostatic hyperplasia. PATIENTS AND METHODS: Radioligand-binding assays using 3H-prazosin were performed on prostatic tissue obtained from 25 patients, 10 of whom had received a single TUMT whilst the remaining 15 patients had not, and acted as controls. Prostatic tissue was obtained by cold-punch biopsy immediately before transurethral resection of the prostate from 20 patients (10 following microwave treatment and 10 controls) and from a further five patients at the time of retropubic prostatectomy; these five patients again had undergone TUMT. There were no statistically significant differences in several variables between the groups except for the weight of resected tissue, which was greater for the patients undergoing retropubic prostatectomy. Differences in the maximum receptor density (Bmax) and dissociation constant (Kd) were analysed statistically using the Mann-Whitney U-test because the data were non-parametric. RESULTS: Binding was saturable and a single class of high-affinity binding sites was identified in all cases. In the control group, the mean and 95% confidence interval (CI) alpha-1 adrenoreceptor density (Bmax) was 96.4 (82.7-110.1) fmol/mg and the mean (95% CI) dissociation constant (Kd) was 0.56 (0.37-0.74) nmol/l. In those patients who had undergone TUMT, the mean Bmax was significantly lower at 71.3 (58.6-84.7) fmol/mg (P < 0.02) but the Kd of 0.56 (0.20-1.14) mmol/L was identical to that in the control group. CONCLUSIONS: Single-session TUMT, using a non-irrigated catheter, causes a significant reduction in prostatic alpha-1 adrenoreceptor density in the region of the prostate subjected to maximum beating. This may represent one possible mechanism of action by which microwave treatment exerts its beneficial effects.

A sham controlled trial of transurethral microwave therapy with subsequent treatment of the control group.

To investigate whether there is a significant placebo component to the improvements seen after 1-session transurethral microwave treatment, 40 patients with significant symptoms of prostatism and unequivocally benign glands were recruited to take part in a sham controlled study. After an active treatment the mean American Urological Association symptom scores improved by 63% (19.2 to 7.1) while after a sham treatment symptom scores improved only marginally (18.8 to 16.2, p < 0.001). Residual volumes decreased by 50% (104 to 52 ml.) and flow rates increased by 2.3 ml. per second after an active treatment with no improvement after a sham treatment. There was a consistently greater improvement after an active treatment compared to a sham treatment. Patients who had received a sham treatment were then offered an active treatment and showed improvements similar to those in the original actively treated group and much greater than after the original sham treatment. Mean symptom scores decreased from 16.2 to 9.9 (p < 0.004). Residual volumes decreased from 94 to 40 ml. (p < 0.005) and flow rates increased by 1.6 ml. per second, while these same criteria had deteriorated after a sham treatment. Side effects were mild and short lived, with no patients reporting sexual dysfunction as a consequence of treatment. Transurethral microwave therapy is an effective well tolerated treatment for select patients with benign prostatic hypertrophy and the placebo effect of treatment is minimal.

Transurethral microwave therapy: patient selection and outcome.

Forty-one patients with benign prostatic disease awaiting transurethral resection of the prostate were offered transurethral microwave therapy as an alternative. Pre-operative assessment consisted of symptom scores, prostate-specific antigen levels, flow rates and urinary tract ultrasound with residual urine estimation. Patients were reassessed 6 weeks, 3 months and 6 months after microwave treatment. Twenty-three patients had a successful outcome and 18 an unsuccessful outcome to treatment. Fifteen of the 18 with an unsuccessful outcome could have been predicted by the presence of one or more of the following pretreatment features: glands over 50 g (10 patients), the presence of a median lobe (5 patients), high residual urine (6 patients), a history of recurrent urinary infection (2 patients) and coexisting neurological disorders such as parkinsonism (1 patient) and CVA (1 patient). Three failures had none of these criteria present and could not have been predicted from their pretreatment assessment. Transurethral microwave therapy produces subjective and objective improvements in appropriately selected patients. Patients with large glands or decompensated bladders fail to benefit and should continue to be treated by conventional surgery.

Phase contrast microscopic examination of urinary erythrocytes to localise source of bleeding: an overlooked technique?

AIMS: To localise the source of bleeding in the urinary tract in patients presenting with haematuria. METHODS: Urine samples were obtained from 109 patients with symptoms referable to the urinary tract. The sample was examined for the presence of red blood cells by phase contrast microscopy (PCM) and the proportion of dysmorphic and isomorphic red blood cells was determined. If more than 20% of the red blood cells were dysmorphic a glomerular origin for the site of bleeding was suspected; if less than 20% of the red blood cells were isomorphic a non-glomerular origin was suspected. Phase contrast microscopy and clinical findings were correlated. RESULTS: The correct bleeding site was shown in 27 of 30 (90%) patients with glomerulopathy and in all 17 patients with bleeding from the lower urinary tract, indicating that this method of analysis has a sensitivity of 90% and specificity of 100% for detecting the glomerular source of bleeding. CONCLUSIONS: The examination of urine for dysmorphic and isomorphic red blood cells by phase contrast microscopy is strongly recommended in routine clinical practice for the detection of glomerular and non-glomerular lesions. This technique may avoid unnecessary investigations for the diagnosis of the site of bleeding in patients with haematuria.

Transurethral microwave treatment for benign prostatic hypertrophy: a randomised controlled clinical trial.

OBJECTIVES: To determine whether transurethral microwave treatment for patients with benign prostatic hypertrophy provides significant symptomatic relief, a reduction in residual urine volumes, and improvements in flow rates compared with sham treatment. DESIGN: Prospective double blind randomised study with follow up at three months. SETTING: Department of Urology in a London teaching hospital. PATIENTS: 40 men completed the study: 22 received microwave treatment and 18 received sham treatment. Entry criteria were symptoms of prostatism of at least six months' duration, a total symptom score > 14, and a peak urine flow rate < 15 ml/s or a residual urine volume > 50 ml. Exclusion criteria were prostatic cancer, a residual urine volume > 200 ml, a very large prostate, an obstructing middle lobe, acute urinary retention, impaired renal function, coexisting urinary tract disease, and previous prostatic surgery. INTERVENTIONS: A single 90 minute transurethral microwave treatment or sham treatment. OUTCOME MEASURES: Patients' symptoms (including daytime frequency and nocturia) recorded in a self assessment symptom score questionnaire, peak urinary flow rates, and residual urine volumes. RESULTS: The mean total symptom scores of the patients who received microwave treatment fell from 30 to 11 compared with a fall from 31 to 26 for patients who received sham treatment (p < 0.001). Among patients who received microwave treatment daytime frequency fell from 9.4 to 5.5 voids a day and night time frequency from 3.5 to 1.6 voids a night; residual urine volumes fell from 104 ml to 52 ml; and peak urine flow rates increased by 2.3 ml/s. In the control group there was no improvement in any of these features. Treatment preserved sexual function and antegrade ejaculation. CONCLUSIONS: For selected patients with prostatism microwave treatment is effective and has few side effects.