Transurethral microwave therapy

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Transurethral microwave therapy (TUMT) uses microwave heat to shrink excess prostate tissue. Doctors insert a small microwave antenna attached to a flexible tube (catheter) through your penis into the part of the urethra surrounded by the prostate gland. The antenna emits a dose of microwave energy that heats overgrown prostate cells and destroys them without damaging nearby normal tissue. Water circulates around the tip and sides of the antenna during the procedure to protect the urethra from heat. A balloon with a heat sensor is inserted into your rectum to monitor temperature.

What to expect. TUMT takes about 45 minutes. It's usually done as an outpatient procedure. A local anesthetic helps to control pain. Usually intravenous sedation is required. You may feel some heat or pain in the prostate and bladder areas. You may also have a strong desire to urinate and may experience bladder spasms — sensations that usually go away after the treatment is finished. Many men require a catheter for two or three days after the procedure. For a few days or even weeks, it's normal to have urgent, frequent urination and small amounts of blood in your urine. Most men resume routine activities and sexual functioning in a week or two.

Who it works best for. TUMT works best for men with moderately enlarged glands and moderate symptoms. It doesn't work as well if your prostate enlargement has occurred mainly in the gland's middle lobe, which grows upward and presses into your bladder. In such cases, the microwave antenna may not produce enough energy to reach the obstructing part of your prostate. Because of potential complications, TUMT isn't recommended if you have a penile implant, an artificial urinary sphincter or certain health problems. It's also not recommended if you have had radiation treatments in the pelvic area or if you have had pelvic surgery. If you have a pacemaker or an implanted defibrillator, you will need to consult with your cardiologist and see whether the device can be deactivated for the procedure. Your doctor will perform cystoscopy before deciding to use TUMT to be sure that your internal anatomy is suitable for the procedure.

Outcome. TUMT is more effective than medications at improving urine flow, but is less effective than is traditional prostate surgery (TURP). However, TUMT does improve urinary flow in most men who undergo the procedure. TUMT decreases symptom index scores an average of nine to 11 points, compared with 14 to 20 points for surgery. Some doctors consider TUMT the best choice among the minimally invasive treatments currently available.

Several weeks may pass before you see a noticeable improvement in your urinary symptoms. That's because your body needs time to break down and absorb overgrown prostate tissue that's been destroyed by the microwave energy. The long-term effectiveness of the procedure is still unknown.

Side effects. Painful urination can persist for several weeks after TUMT — until your body completely absorbs the destroyed prostate tissue. Most men require a catheter for a few days after the procedure.

Other side effects:

Temporary urinary urgency or frequency may occur depending on the microwave device used and how likely it is to produce these side effects.
Urinary tract infection occurs in some men. It's more likely to occur the longer you require a catheter.
Narrowing (stricture) of the urethra may develop and may require additional treatment.
Decreased amount of semen ejaculated may occur. TUMT rarely causes erection problems or incontinence. Retrograde ejaculation — a condition in which semen flows backward into the bladder during ejaculation — occurs in about one in five men who have the procedure.

Need for re-treatment. The need for additional treatment after TUMT is more likely than it is after standard surgery, either because symptoms return or because they never adequately improve. Some men who undergo TUMT later require more treatment — usually surgery.