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Transurethral microwave therapy (TUMT)
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/tumt/MY00607
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Definition
Transurethral microwave therapy (TUMT) is an outpatient procedure to treat urinary symptoms caused by an enlarged prostate, also known as benign prostatic hyperplasia (BPH). It's used less often now than it was in the past and has generally been replaced by newer treatments.
During TUMT, a small microwave antenna is inserted through the tip of your penis into the tube that carries urine from your bladder (urethra). The antenna is extended until it reaches the area of the urethra surrounded by the prostate. Your doctor then uses the antenna to emit a dose of microwave energy that heats up and destroys excess prostate tissue blocking urine flow.
TUMT is one of several options for treating an enlarged prostate. To determine the best treatment choice for you, your doctor will consider how severe your symptoms are, what other health problems you have, and the size and shape of your prostate.
Before doing any enlarged prostate procedure, your doctor may want to do a test that uses a visual scope to look inside your urethra and bladder (cystoscopy). This allows the doctor to check the size of your prostate and examine your urinary system. Your doctor may also want to do other tests, such as blood tests or tests to measure urine flow.
Why it's done
TUMT is a treatment to ease urinary symptoms and complications resulting from blocked urine flow, such as:
- A frequent, urgent need to urinate
- Difficulty starting urination
- Slow (prolonged) urination
- Increased frequency of urination at night (nocturia)
- Stopping and starting again while urinating
- The feeling you can't completely empty your bladder
- Urinary tract infections
TUMT is not done to treat prostate cancer.
Other enlarged prostate procedures include transurethral resection of the prostate (TURP), transurethral needle ablation (TUNA), transurethral incision of the prostate (TUIP), laser surgery such as holmium laser enucleation of the prostate (HoLEP) or laser photovaporization of the prostate (PVP), and open prostatectomy.
TUMT improves urinary flow in some, but not all, men. This procedure is generally more effective than are medications at improving urine flow, but less effective than is surgery (TURP or open prostatectomy). TUMT is less involved than surgery is and has a lower risk of side effects than do the more-invasive surgeries.
Only men with prostates of a certain size and shape can benefit from TUMT. It works best for men who have a moderately enlarged prostate. It may not be effective if your prostate has an enlarged middle lobe that grows upward into your bladder. In such cases, the microwave antenna may not produce enough energy to reach the part of your prostate blocking urine flow.
In the long term, surgery is more effective than is TUMT for relieving urinary symptoms. But TUMT has several advantages over surgery:
- It's done without an overnight hospital stay (on an outpatient basis).
- It's less likely to cause erectile dysfunction or other sexual side effects.
- It doesn't require general or spinal anesthesia.
- It has a lower risk of causing heavy bleeding.
- It may be a safer alternative if surgery isn't a good choice for you because of certain other health problems.
Risks
Risks of TUMT include:
- Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An infection is increasingly likely to occur the longer you have a tube to drain urine (urinary catheter) in place after the procedure. It may require antibiotics or other treatment.
- Narrowing (stricture) of the urethra or bladder neck. Sometimes TUMT narrows the tube that carries urine from the bladder (urethra), or the area where the urethra attaches to the bladder (bladder neck). This can make urination difficult and may require additional treatment to correct.
- Dry orgasm. TUMT can cause retrograde ejaculation, which means semen released during sexual climax (ejaculation) enters your bladder rather than exiting the penis. Retrograde ejaculation isn't harmful and generally doesn't affect sexual pleasure. But it can interfere with your ability to father a child.
- Damage to the genitals. Unintentional overexposure to microwave radiation can cause serious damage to the penis, urethra or other parts of the genital area. This is rare.
- Need for retreatment. Some men who have TUMT later require follow-up treatment with TURP or another prostate procedure. Treatment is needed either because symptoms return or because they never adequately improve.
Because of potential complications, TUMT may not be a treatment option if you have or have had:
- A penile implant
- Certain types of surgery in the pelvic area
- Urethral stricture — narrowing of urethra
- Radiation treatments in the pelvic area
- A pacemaker or an implanted defibrillator — talk with your doctor to find out whether the device can be deactivated for the procedure
How you prepare
Follow your doctor's instructions on what to do before your treatment. Here are some things that you may need to do:
- Ask about blood-thinning medications. Your surgeon may ask you to stop taking medications that increase your risk of bleeding several days prior to the procedure. These include warfarin (Coumadin), clopidogrel (Plavix), and nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Talk to the doctor who prescribed your medication before you make any changes.
- Don't eat before your procedure. Your doctor may ask you to not eat or drink anything after midnight. On the morning of your procedure, take only the medications your doctor tells you to with a small sip of water.
- Arrange a ride home. You won't be able to drive yourself home after the procedure.
Your doctor may also give you other steps to follow.
What you can expect
TUMT takes less than an hour. It's usually done as an outpatient procedure, which means you'll go home the day of the procedure.
You'll be given a local anesthetic to numb the prostate area. The anesthetic may be inserted through the tip of your penis, or given in a shot via your rectum or in the space between your scrotum and anus (perineum).
You'll likely have intravenous (IV) sedation. With IV sedation, you'll be drowsy but remain conscious during the procedure.
During the procedure
Once the anesthetic is working, your doctor will insert a catheter with a microwave antenna into your urethra. A thermometer is inserted into your rectum to check temperature. Both will have balloons attached that hold them in place. Your doctor may check the placement of the catheter and the rectal thermometer using an ultrasound machine.
Once the antenna is in exactly the right place, your doctor will start the procedure. The microwave antenna will cause just enough heat to destroy the prostate tissue blocking your urine flow, but not enough to damage other tissue.
During microwave treatment, water circulates around the tip and sides of the antenna to protect the urethra from heat. Your doctor will give you enough pain medication so that it won't hurt too much — but you'll still feel some heat and discomfort in the prostate and bladder areas. Your doctor will tell you how much discomfort to expect during the procedure and may show you how to use an emergency stop button if the pain gets too bad.
Feeling a little discomfort during the procedure is necessary. Your doctor will ask you about your pain level and adjust your treatment to make sure you're getting enough heat to improve your symptoms — but not so much that it causes unnecessary damage. You'll need to stay as still as possible during the actual microwave treatment. The length of treatment time varies depending on your doctor's preference and the type of microwave therapy machine used.
During treatment, you may have a strong desire to urinate and may feel bladder spasms — sensations that usually go away after the treatment is finished.
After the procedure
After TUMT, you may have a tube (catheter) inserted into the tip of your penis that extends into your bladder. This allows you to pass urine until you can urinate on your own.
After the procedure, follow your doctor's instructions for recovery.
- Don't take blood-thinning medications until your doctor says it's OK.
- Don't do any strenuous activity, such as heavy lifting, for three to five days.
- Don't drive for the rest of the day after your procedure.
- Don't have sex until your doctor says it's OK. Most men can resume sexual activity about two weeks following the procedure.
Short-term side effects of TUMT can include:
- Blood in your urine (hematuria) for a few days after the procedure.
- Irritating urinary symptoms such as painful urination, difficulty urinating, or an urgent or frequent need to urinate. These symptoms usually improve within a few weeks.
Results
Several weeks to months may pass before you see a noticeable improvement in urinary symptoms. That's because your body needs time to break down and absorb overgrown prostate tissue that's been destroyed by microwave energy.
Some men need retreatment in time. More studies are needed to determine the overall, long-term effectiveness of TUMT compared with other procedures.
After TUMT, it's important to have a digital rectal exam once a year to check your prostate and screen for prostate cancer, as you would normally. If you notice any worsening urinary symptoms, make an appointment to see your doctor.
- Fitzpatrick JM, et al. Minimally invasive and endoscopic management of benign prostatic hyperplasia. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/125743340-3/0/1445/91.html?tocnode=54305416&fromURL=91.html. Accessed Jan. 27, 2011.
- Guideline on the management of benign prostatic hyperplasia (BPH). Linthicum, MD. American Urological Association. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bph. Accessed Jan. 27, 2011.
- d'Ancona FC. Nonablative minimally invasive thermal therapies in the treatment of symptomatic benign prostatic hyperplasia. Current Opinion in Urology. 2008;18:21.
- Cunningham GR, et al. Surgical and other invasive therapies of benign prostatic hyperplasia. http://www.uptodate.com/home/index.html. Accessed Jan. 2, 2011.
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