A pilot study was undertaken using the Prostathermer, the Primus and the Thermex-II devices to treat a total of 48 patients with proven outflow tract obstruction. All patients showed severe obstruction and had a mean pre-treatment flow rate of 8.8 ml/s and a mean post-micturition residual urinary volume of 120 ml. The mean symptomatic score (Madsen-Iverson score) was 14. When all three treatment groups are considered as one, the post-treatment flow rate improved to 11.1 ml/s. The post-micturition residual urinary volume fell to 46 ml and the mean symptom score fell to 8. Follow-up involved only a maximum of 12 months, but during this time only four patients in the group agreed to undergo a prostatectomy and 88% of the group were considered to have insufficient symptoms to warrant prostatectomy, although all of the patients were considered to be candidates for prostatectomy prior to treatment. The treatment is discussed in the light of the literature on placebo response in prostatic outflow obstruction.
Transurethral resection of hyperplastic prostatic tissue (TURP) is the conventional therapy for urinary outflow obstruction caused by benign prostatic hyperplasia (BPH). This procedure, which results in symptomatic improvement in approximately 70% of patients, requires hospitalization with catheter drainage. Complications and side effects, although seldom severe, include dysuria, blood transfusion, infection, incontinence, retrograde ejaculation, urethral stricture, and impotence. In addition, some patients have severe medical illness that increases anaesthetic and surgical risk.
Several hyperthermia devices are now available, and the majority use microwaves to heat the prostate using either a transrectal or a transurethral probe. These treatments are performed on an outpatient basis without general or regional anaesthesia, and both the transrectal and