Transurethral microwave thermotherapy vs transurethral resection for treating benign prostatic hyperplasia: a systematic review

Technology has been used in the management of BPH, sometimes without much evidence to support its use. The first manuscript is a systematic review of the literature comparing transurethral microwave therapy to TURP. This shows that although microwave therapy is safe and effective in the short term, it is not as effective as TURP. Authors from London report on their long‐term (up to 12‐years of follow‐up) results when using the Urolume wallstent for urethral stricture. They describe the results in detail, and conclude that the stent should only be used in patients who are unfit for or who refuse urethroplasty. OBJECTIVE To conduct a systematic review of randomized controlled trials evaluating the efficacy and safety of transurethral microwave thermotherapy (TUMT) compared with transurethral resection of the prostate (TURP) in treating men with symptomatic benign prostatic hyperplasia (BPH). METHODS We searched Medline, the Cochrane Library and reference lists of retrieved studies to identify randomized trials of ≥ 6 months duration with ≥ 10 patients in each treatment arm. Data were extracted on study design, patient and treatment characteristics, urinary symptoms, urinary flow, adverse events and repeat treatment for BPH. RESULTS Six studies were evaluated, involving 540 patients. The mean age (67.8 years), baseline symptom score (19.5), and peak urinary flow (PUF, 8.6 mL/s) did not differ by treatment group. The pooled mean urinary symptom score decreased by 65% with TUMT and 77% with TURP. The weighted mean (95% confidence interval) difference for the symptom score at the follow‐up was −1.83 (−3.09 to −0.58) points, favouring TURP. The pooled mean PUF increased by 70% with TUMT and 119% with TURP. The weighted mean difference for the PUF at the follow‐up was 5.37 (4.22–6.51) mL/s, favouring TURP. Retrograde ejaculation (57.6% vs 22.2%), transfusions (5.7% vs 0%) and re‐treatment for strictures (relative hazard 9.76) were all significantly more common after TURP, but re‐treatment for BPH was significantly more common after TUMT (relative hazard 10.0). CONCLUSIONS TUMT techniques are effective and safe short‐term alternatives to TURP for treating BPH. However, TURP provided greater symptom and urinary flow improvements and fewer subsequent BPH treatments than TUMT.