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What are the results of laser therapy?

Laser therapy for BPH is a relatively new technique, thus series with large numbers of patients followed over an extended period of time are limited. In a Cochrane review of 20 studies involving 1,898 patients, laser techniques were found to be useful and relatively safe alternatives to TURP. Improvements in LUTs and urine flow rate were noted to be slightly better in the TURP group, though laser procedures had fewer side effects and required shorter hospitalization. In one recent study comparing TURP to contact laser treatment, comparable subjective improvements with an average follow-up of 10 years postprocedure, however, only with patients treated with TURP showed durable objective improvements at an average follow-up of 10 years. As with any procedure, it is important to ask your doctor about his/her personal results with performing the procedure.

What is microwave therapy of the prostate?

Microwave energy has been used to treat BPH using both transrectal and transurethral approaches, but most modern machines use the transurethral route. Current machines deliver microwave energy to the prostate via a transurethral catheter, and a transrectal balloon monitors rectal temperature simultaneously.

The treatment is delivered under local anesthesia on an outpatient basis and typically takes about one-half hour. The patient will go home with an indwelling urethral catheter for a period of days at the discretion of the urologist.

What are the results of microwave therapy?

Results after microwave therapy are either subjective and objective. Subjective results use patient symptoms score sheets where the patients record their perception of their voiding characteristics. Objective results, such as measurements of peak urinary flow rates and post void residual volumes, are measured by the physician. Several studies have shown improvement in both subjective and objective measurement following microwave therapy. This technology is still relatively new, and long-term data are lacking. No one yet knows whether these promising early results are durable.

In a Cochrane review, microwave therapy was found to be a relatively safe and effective treatment option for BPH. Microwave therapy has fewer, as well as less severe, side effects than TURP. TURP produced greater improvement in urinary symptoms and fewer men required retreatment for symptomatic BPH.

This technique involves placing interstitial radiofrequency needles through the urethra into the lateral prostatic lobes to cause coagulation necrosis.

What is radiofrequency therapy of the prostate and the results of radiofrequency therapy?

Radiofrequency treatment of BPH is commonly referred to as TUNA—transurethral needle ablation of the prostate. This technique involves placing interstitial radiofrequency needles through the urethra into the lateral prostatic lobes to cause coagulation necrosis. The tissue is heated to 110°C at a radiofrequency power of 490 KHz for 4 minutes per lesion. The number of times the needles are placed into the prostatic lobes is at the discretion of the urologist based on the size of the prostate gland.

The TUNA device and generator are shown in Figures 26 and 27. Two needles that are at 60 degree angles to each other are deployed into the prostatic tissues by piercing the prostatic urethra. Each treatment with the needles treats prostate tissue about 1 cm in diameter.

Precision™ Plus Hand Piece.

Figure 26. Precision™ Plus Hand Piece.

Courtesy of Medtronic, Inc. © Copyright 2003.

Precision™ Plus System (computer and hand piece).

Figure 27. Precision™ Plus System (computer and hand piece).

Couresty of Medtronic, Inc © Copyright 2003.

Table 14. TUNA Combined Statistics

Month Post Treatment

Number Patients

Preoperative

Postoperative

Percent Change

IPSS decrease

0

254

22

Patient rerated

3

213

9

59

Symptom scores

6

150

8

64

12

29

Qmax increase

0

254

8 ml/second

Maximum

3

219

13

63

Urinary flowrate

6

136

13

63

12

35

14

75

Source: Loughlin, P. 100 Questions and Answers About Prostate Disease. Jones and Bartlett Publishers, LLC, 2007.

TUNA of the prostate uses radiofrequency energy to treat the patient. As with most of the other MIST results, few long-term data are available, and thus, results must be viewed with caution.

Table 14 contains combined TUNA results using both subjective and objective criteria.

 
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