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Microwave

Transurethral microwave thermotherapy (TUMT) is a minimally invasive BPH treatment that uses heat to ablate obstructive prostatic tissue and reduce symptoms of the condition. This treatment often is used in patients who no longer respond to medication and those who prefer to avoid surgery and its risks.

Microwave thermotherapy usually is performed in an outpatient setting, under local anesthesia. There are many systems available to perform this procedure, and prostate size and patient and physician preference help determine which system is used. In most cases, treatment takes less than an hour, causes few side effects, and produces results that are comparable to transurethral resection of the prostate (TURP).

During treatment, microwaves, which are radio waves varying from 1 mm to 30 cm in length, are delivered to the prostate via a probe inserted into the gland through the urethra. Intraprostatic temperature is monitored during microwave thermotherapy to reduce the risk for damage to surrounding structures. Following the procedure, patients usually require catheterization to prevent urinary retention.

The goals of microwave thermotherapy are to provide durable results, preserve sexual function, and reduce the risk for serious side effects.

CoreTherm®
The CoreTherm® system is an individualized treatment in which microwave power and treatment time are adapted to intraprostatic temperature to increase the effectiveness and decrease the risks. This system may be indicated for prostates larger than 35 mm and those with volume from 30–100 g. Studies have shown that CoreTherm® effectively reduces BPH symptoms in more than 80% of cases.

Prior to treatment, the urologist determines a treatment goal (e.g., a 30% reduction in prostate volume). During the procedure, data are calculated and displayed on a computer screen to help the physician adjust the microwave power and determine when the goal has been achieved.

Before CoreTherm® begins, an anesthetizing gel is inserted into the urethra. When the anesthesia takes effect, the catheter is inserted through the urethra into the prostate. The catheter contains a microwave probe, which heats and coagulates prostatic tissue, and a temperature sensor, which monitors intraprostatic temperature during the procedure. Additional sensors are placed around the penis and in the rectum to help prevent tissue damage to these areas. Treatment usually takes from 15–70 minutes.

Following the procedure, patients are able to go home immediately. Urinary retention is a common temporary side effect, and most patients require a catheter for at least 5 days to drain urine. Other complications include urgency and urinary infections.

In the weeks following treatment, destroyed prostatic tissue is discharged in the urine. Symptoms continue to improve for 2–3 months. The procedure can be repeated, if necessary, in 6 months.

Cooled ThermoTherapy™/TUMT™
Targis® is a portable cooled thermotherapy system. It consists of a control unit, a microwave delivery system (MDS), a cooling bag, and a rectal thermosensing unit (RTU). The control unit consists of a microwave generator, a refrigerating device, and a circulation pump. It supplies microwave energy and coolant to the MDS and collects and processes data from the MDS and the RTU.

The MDS consists of an antenna to deliver microwave energy to the prostate and a thermosensor to monitor urethral temperature. The cooling bag contains sterile water that is cooled and circulated during treatment, and the RTU monitors rectal temperature. The MDS, cooling bag, and RTU are single-use devices.

Before treatment, patients are given an enema to improve the accuracy of the RTU. During treatment, the MDS is inserted into the prostate through the urethra and the RTU is inserted into the rectum. Microwave energy is then calibrated and cooled water is circulated through the MDS. When the MDS temperature is 35° C, microwave energy is delivered to the prostate.

Treatment lasts from 30–60 minutes, during which time, a urethral temperature of 40° C is maintained. When the targeted prostatic tissue is sufficiently heated, treatment is ended and coolant is circulated for 5 minutes to reduce the risk for damage to the prostatic urethra.

Following treatment, most patients require catheterization for 2–4 days due to urethral swelling. Anti-inflammatory medication and antibiotics may be prescribed.

The Prostatron® cooled thermotherapy system reduces BPH symptoms, preserves sexual function, and provides durable results. It is available in three treatment protocols: Prostasoft 2.0, Prostasoft 2.5, and 30 Minute TUMT for obstructive BPH. Prostasoft 2.0 often is indicated for patients when drug therapy is ineffective. Prostasoft 2.5 and 30 Minute TUMT produce results similar to transurethral resection of the prostate (TURP), without the serious risks.

Treatment takes about 1 hour and is performed under local anesthesia. During treatment, the Prostatron® system delivers microwave energy via a probe encased in a catheter, which is inserted into the prostate through the urethra.

A fiberoptic sensor and cooling system also are inserted through the catheter. The sensor monitors the temperature within the prostate. The cooling system circulates water to minimize patient discomfort, protect adjacent urethral tissues from excessive temperatures, and reduce the risk for serious side effects.

After treatment, destroyed prostatic tissue is discharged in the urine or reabsorbed by the body. Catheterization usually is necessary to prevent urinary retention.

Complications include mild-to-moderate frequency, urgency, and straining. These usually resolve without intervention within a few weeks. Most patients can resume normal activity immediately after treatment.

TherMatrx DOT® (Dose-optimized Thermotherapy)
TherMatrx DOT® delivers microwave energy through a flexible catheter that contains a patented microwave antenna. This treatment targets periurethral prostate tissue, without affecting tissues of the ejaculatory ducts or the rectum. TherMatrx DOT® uses a series of multiple feedback loops to constantly monitor the procedure and identify and utilize the optimal dose of microwave energy to treat BPH. It delivers the correct dose to precisely the right tissue, maximizing safety, minimizing discomfort, and providing durable results.

Patients who undergo TherMatrx DOT® may receive mild oral medication before the procedure. Treatment takes 90 minutes to 2 hours to perform. Patients may experience slight discomfort, a warm feeling in the groin, and the urge to urinate during treatment.

Side effects are mild, self-resolving, and occur at a lower incidence than with other microwave devices. Patients are able to go home right after treatment and require a catheter for 2–5 days. Normal activity can be resumed after 24 hours.

Relief of symptoms occurs gradually over 4–6 weeks and continues for about 6 months as prostatic tissue heals. One year after treatment, most patients are satisfied with the results of therapy.

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