7° Congresso Nazionale

7° Congresso Nazionale Associazione Italiana di Endourologia
Minimally invasive treatments for LUTS related to BPH:
an update.
Summary
D. Prezioso, R. Galasso, G. Iapicca, E. Annunziata, F. Iacono
Department of Urology, “Federico II” University of Naples
Objective: The aim of our review is to provide updated information regarding the role
of minimally invasive endourological techniques to treat lower urinary tract symptoms
(LUTS) due to benign prostatic hyperplasia (BPH). We reviewed the literature and the
BPH guidelines, focusing the attenction on randomized controlled trials with significant
number of patients and long-term follow up series. We have considered a large
number of parameters related to minimally invasive interventions, such as the short- and longterm
outcome, complications, morbidity, need for anaesthesia, also comparing the current data
regarding the trans-urethral resection of prostate (TURP).
Results: The minimally invasive therapies can be divided into: thermal-based tehrapies, laser
therapies, ablative therapies and other technologies. They represent a good alternative to
TURP, with interesting results regarding their efficacy and tolerability. The most attractive
treatments are high-energy trans-urethral microwave thermotherapy (TUMT), holmium-laser
resection/enucleation (HoLRP/HoLEP), bipolar trans-urethral resection in saline (TURIS) and
transurethral electrovaporization (TUVP). However, also other new interventions show a good
safety profile and low economical costs.
Conclusions: Today, minimally invasive treatments are a good alternative to traditional TURP,
but prospective, long-term randomized trials are need to evaluate the real outcome.
KEY WORDS: Minimally invasive treatments; Trans-urethral microwave thermotherapy;
Holmium-laser resection/enucleation; Bipolar trans-urethral resection in saline;
Transurethral electrovaporization, Trans-urethral needle ablation.
INTRODUCTION
For a long period of time, transurethral resection of the
prostate (TURP) was considered the “gold standard” surgical
therapy for patients with LUTS related to BPH (1),
associated with significant efficacy (2), but also with
severe morbidity (3-6).
New surgical and minimally invasive treatments show a
comparable efficacy to TURP, with better safety and
lower costs, in terms of quality of life and time of hospitalization.
Aim of this review is to provide updated information
about the role of minimally invasive therapies, analyzing
the evidence-based data of randomized clinical trials and
the recommendations of BPH guidelines (7,8). We
reviewed the literature and the BPH guidelines, focusing
the attenction on randomized controlled trials with significant
number of patients and long-term follow up
series. We have considered a large number of parameters
related to minimally invasive interventions, such as the
short- and long-term outcome, complications, morbidity,
need for anaesthesia, also comparing the current data
regarding the trans-urethral resection of prostate
(TURP).
TRANS-URETHRAL MICROWAVE THERMOTHERAPY (TUMT)
Thermotherapy uses high temperatures to produce coagulation
necrosis of prostatic tissue. Microwaves delivered
via the transurethral route have been the dominant
means used to heat prostatic tissue. TUMT uses a special
transurethral catheter with a microwave antenna that
transmits heat into the prostate with the eventual goal of
destroying tissue by achieving temperatures that exceed
the cytotoxic threshold and inducing cell death. More
specifically, heating in excess of 45°C results in coagulation
necrosis. In addition, apoptosis has been observed,
at temperatures lower than those inducing necrosis.
Recently, it was demonstrated that TUMT increased the
sensory threshold (evoked by electrical stimulation) in
the posterior urethra by 30%, resulting in the alleviation
of storage symptoms (9). During the last decade, numerous
studies have been published presenting the clinical
results from the application of TUMT for the treatment of
LUTS associated with BPH. Many TUMT devices with
different technical specifications and treatment protocols
have been evaluated. Bolmsjo et al (10) reported substantial
differences in heating profiles between devices
with different microwave antenna designs. However, at
Archivio Italiano di Urologia e Andrologia 2007, 79, 3, Supplemento 1
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