"Minimally Invasive Treatment for Enlarged Prostate" By: David L. Bluestein, M.D. - WAOW - Newsline 9, Wausau News, Weather, Sports

"Minimally Invasive Treatment for Enlarged Prostate" By: David L. Bluestein, M.D.

April 2005

David L. Bluestein, M.D.

Urology Specialists of Wisconsin offers a promising minimally invasive heat treatment for enlarged prostate called Cooled TUMT (transurethral microwave thermotherapy). Cooled TUMT is performed as a single 30-minute office procedure with oral medications and topical anesthesia only. Our urologists have extensive experience with this technology, having performed many successful procedures over the past two years. Cooled TUMT is an effective alternative to drugs and surgery for patients with moderate to severe lower urinary tract symptoms associated with an enlarged prostate.

PREVALENCE OF BPH

BPH, or prostate enlargement, affects approximately 50 percent of men over the age of 50. It is the most common cause of lower urinary tract symptoms such as urinary frequency, diminished stream strength, incomplete emptying and nocturia (awakening at night to urinate). BPH is a progressive condition in most men. Historically, drug therapy and surgery have been the sole therapeutic options for men with symptomatic BPH. While surgery may be the best option for some patients and provides a high degree of symptomatic relief, it comes with potential risks and costs. Medication is a more convenient alternative to surgery because it allows patients to avoid hospitalization. However, medication does not provide the same results as surgery in terms of symptom relief or improvement in urinary flow rates.

COOLED TUMT

Cooled TUMT is a nonsurgical, 30-minute office procedure that has been FDA approved since 1996 and is covered by Medicare and most private insurers. It has been endorsed by the BPH treatment guidelines issued by the American Urological Association since 2003. Cooled TUMT treats BPH by applying microwave energy to the prostate and continuously heating the obstructing tissue via a transurethral microwave delivery system (Figures 1 & 2). It also minimizes patient discomfort and risk to the urethra by circulating cooling fluid through the microwave delivery system. The temperatures within the prostate reach a thermal threshold above 50° C and effectively destroy the enlarged prostatic tissue. This leads to resorption of the dead tissue and improvement in urinary symptoms. Urethral and rectal temperatures are monitored continuously throughout the procedure to assure patient safety. Patients go home directly after the treatment and can usually resume normal activities immediately.

Figure 1 Targis in position
Figure 1

Figure 2 Microwave Energy Shrinks Tissue
Figure 2

RESULTS OF TUMT

This procedure was first used in the early 1990s in FDA-controlled clinical trials. Since then, multiple studies conducted at more than 50 centers worldwide have demonstrated significant symptom and urine flow improvements with minimal complications. A head-to-head randomized study of Cooled TUMT vs. medical therapy demonstrated significantly superior clinical outcomes for Cooled TUMT (Figures 3 & 4). The study concluded that the TUMT group experienced a 35 percent greater reduction in symptom score, a 22 percent greater increase in peak urinary flow rate, and a 43 percent greater improvement in quality of life after 18 months than the group on medication. The overall rate of patient satisfaction with this procedure is approximately 80 percent.

Figures 3 & 4 Results of TUMT

SUMMARY

Cooled TUMT represents a new era of treatment for symptomatic lower urinary tract symptoms secondary to enlarged prostate. While medical management and surgery have clear and continuing roles, Cooled TUMT offers a safe, highly effective, well-studied, minimally invasive alternative option. Clinical studies have demonstrated sustained results with significant symptom improvements, minimal post-treatment complications and minimal treatment discomfort.

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