The impact of transurethral microwave thermotherapy on erectile function and lower urinary tract symptoms in men with benign prostatic hyperplasia – short communication

Roger Ziętek, Stanisław Czeszak, Zbigniew Ziętek


Introduction: Although microwave thermotherapy is becoming an almost forgotten therapy, occasional reports confirm that transurethral microwave thermotherapy (TUMT) still seems to be a good alternative for benign prostate hyperplasia (BPH). The aim of this study was to re-evaluate the advantages and disadvantages of TUMT.
Materials and methods: The non-randomized study included 4590 patients with BPH. All patients were on pharmacological treatment. Prior to the study, patients underwent digital rectal examination (DRE), ultrasound examination, urodynamic examination, and prostatic specific antigen (PSA) concentration. Exclusion criteria included suspected prostate cancer on DRE, an ambiguous result of the urodynamic examination, suggesting a neurological component in lower urinary tract symptoms (LUTS), and elevated PSA concentration. In the end, 3329 patients were enrolled for further analysis. Of this group 2159 patients elected to receive TUMT. The others decided to continue their pharmacotherapy. Two questionnaires were used to evaluate the effect of TUMT on the relief of urinary symptoms and erectile dysfunction (ED). The International Prostate Symptom Score (IPSS) was used for LUTS and the International Index of Erectile Function-5 (IIEF-5) for ED.
Results: After 6 months from thermotherapy, more than 50% of patients experienced an improvement in their urination (p < 0.0018), while in the pharmacological group only 30% did (p < 0.031). Approximately 28% of all patients regained erection. Before thermotherapy, only 12% reported no erection problems. In contrast, a further deterioration of erectile function (EF) was observed in the reference group (differences with TUMT at p < 0.0001). Apart from transient fever or temporary urinary retention, no serious complications were observed.
Conclusions: It appears that TUMT is still a valuable option for BPH, especially in outpatient practice and for those patients who wish to protect their EF.


thermotherapy; conservative treatment; erectile dysfunction; lower urinary tract symptoms; complication; benign prostatic hyperplasia (BPH)

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Hoffman RM, Monga M, Elliott SP, Macdonald R, Langsjoen J, Tackling J, et al. Microwave thermotherapy for benign prostatic hyperplasia. Cochrane Database Syst Rev 2012;9:CD004135.

Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol 2004;46(5):547-54.

Franco JV, Garegnani L, Escobar Liquitay CM, Borofsky M, Dahm P. Transurethral microwave thermotherapy for the treatment of lower uri-nary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev 2021;6(6):CD004135. doi: 10.1002/14651858.CD004135.pub4.

Gravas S, Cornu JN, Gacci M, Gratzke C, Herrmann TRW, Mamoulakis C, et al. Management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). Helsinki: European Association of Urology; 2019.

Nørby B, Nielsen HV, Frimodt-Møller PC. Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermo-therapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic be-nign prostatic hyperplasia. BJU Int 2002;90(9):853-62.

Yu X, Elliott SP, Wilt TJ, McBean AM. Practice patterns in benign prostatic hyperplasia surgical therapy: the dramatic increase in minimally invasive technologies. J Urol 2008;180(1):241-5.

Dixon C, Rijo Cedano E, Pacik D, Vit V, Varga G, Mynderse L, et al. Transurethral water vapor therapy for BPH; initial clinical results of the first in man trial and RezūmTM I pilot study. Eur Urol Suppl 2013;12(1):e631.

Abrams P. Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA Guideline Amendment 2020. Letter. J Urol 2021;205(3):938. doi: 10.1097/JU.0000000000001558.

Lerner LB, McVary KT, Barry MJ, Bixler BR, Dahm P, Das AK, et al. Management of lower urinary tract symptoms attributed to benign pros-tatic hyperplasia: AUA Guideline Part I – Initial work-up and medical management. J Urol 2021;206(4):806-17. doi: 10.1097/JU.0000000000002183.

Lerner LB, McVary KT, Barry MJ, Bixler BR, Dahm P, Das AK, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA Guideline Part II – Surgical evaluation and treatment. J Urol 2021;206(4):818-26. doi: 10.1097/JU.0000000000002184.


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