British Journal of Urology (1998), 81, 259–264 Transurethral resection of the prostate vs high-energy thermotherapy of the prostate in patients with benign prostatic hyperplasia: long-term results F.C.H. D’ANCONA, E.A.E. FRANCISCA, W.P.J. WITJES, L. WELLING*, F.M.J. DEBRUYNE and J.J.M.C.H. De La ROSETTE Departments of Urology, University Hospital Nijmegen and *Reinier de Graaf Hospital Delft, The Netherlands Objective To evaluate the outcome and durability of were obstructed according to urodynamic investi- gation and after treatment, 14% remained obstructed. high-energy transurethral microwave thermotherapy (HE-TUMT) in comparison with transurethral resec- In the TUMT group, 67% of patients were obstructed before treatment and 33% remained so afterward. Six tion of the prostate (TURP). Patients and methods Fifty-two patients with BPH and patients (19%) underwent TURP after TUMT (four after 1 year) and two patients were also treated with lower urinary tract symptoms were randomized and treated either by TURP (21 patients; mean prostate medication. One patient underwent a bladder neck incision after TURP to treat bladder neck sclerosis. volume 45 mL, sd 15) or HE-TUMT (31 patients, mean prostate volume 43 mL, sd 12). Long-term results Three patients were not satisfied with the outcome after the additional TURP. were obtained at a mean (sd) follow-up of 2.4 (0.5) years. Conclusion Both treatment modalities show good symp- tomatic and objective results at >2 years of follow- Results During the follow-up, the mean symptomatic improvement stabilized at 56% after TUMT and 74% up. Most re-treatments were performed 1 year after treatment and were based on subjective findings. after TURP. The mean maximum urinary flow rate increased by 62% after TUMT and 105% after TURP. Keywords Prostatic hypertrophy, thermotherapy, micro- waves, transurethral resection, long-term follow-up Before treatment, 78% of patients in the TURP group the outcome of treatment using the high-energy software Introduction version are limited. Studies with a 12-month follow-up showed a low rate of additional surgical interventions Transurethral microwave thermotherapy (TUMT) of the prostate using the ProstatronA device, taking about an after high-energy (HE-) TUMT [5,8,12]. Using the high-energy software, recent results showed a low hour and requiring no anaesthesia, has been shown to be an eCective out-patient procedure for symptomatic re-treatment rate at 2 years of follow-up, with a persist- ent good symptomatic and objective response [13]. In BPH in several sham-controlled studies [1–4]. Clinical studies using the Prostatron 2.5 high-energy software the present study, we describe the long-term results of a prospective randomized study comparing HE-TUMT with showed a substantial improvement in symptoms, with the symptom score decreasing by a mean of 60% and TURP in men with LUTS and BPH. an improvement in maximum urinary flow rate (Q max ) of almost 50% [5–8]. These objective and subjective Patients and methods improvements were sustained for a year. Besides obtaining excellent short-term results, the durability of Fifty-two men (mean age 69 years, range 54–89) with BPH were randomized to undergo HE-TUMT or TURP response should also be favourable if TUMT is to be adopted. After using low-energy TUMT, Dahlstrand et al. (352) between January 1994 and August 1995. The patients were evaluated, treated and followed in a non- [9,10] presented the results compared with TURP and showed a persistent eCect of TUMT for up to 5 years. aBliated hospital, after obtaining their informed consent. The criteria for entry into the study were: men aged However, De Wildt et al. [11] reported a re-treatment rate, either medical or surgical, of 125 from 305 patients 45 years, candidates for TURP with an unequivocally benign prostate, having a total prostatic length of at 3 years after low-energy TUMT. To date, results on 25–50 mm and a prostate volume of 30–100 mL [3], symptoms suggestive of BOO for >3 months, a Madsen Accepted for publication 16 October 1997 259 © 1998 British Journal of Urology