Microwave therapies provide relief for BPH  

Office-based procedures an alternative to surgery

New treatments that can be performed in an office-based surgery setting for benign prostatic hyperplasia (BPH), also known as enlarged prostate, are improving patient comfort and providing more lasting results, according to experts interviewed by Same-Day Surgery.

"BPH is not a disease as much as it is a fact of growing older, much like gray hair and male pattern baldness," says William J. Utz, MD, clinical assistant professor of urology at the University of Minnesota and chairman of the urology department at Abbott Northwestern Hospital in Edina, MN. "The condition affects 50% of men between the ages of 51 and 60, but not all men are symptomatic," he adds.

For those men who do experience the symptoms of frequent or painful urination, several treatments, including medication and surgery, exist, he points out. "The majority of my patients, however, will choose minimally invasive microwave therapy over the more traditional surgical transurethral resection of the prostate if their medication therapy isn’t working," he adds.

"There are also laser treatments for the condition, but they require an operating room in a surgical center because there are specific equipment and anesthesia requirements that are not practical for office settings," Utz adds.

Laser treatments require complete nerve blocks for the patients, which requires an anesthesiologist, surgical drains, the laser, and the ability to block 30 minutes to 1½ hours out of a schedule for the procedure, he continues.

"Not only is the microwave therapy practical in an office setting, but advances have made it more comfortable for the patient," Utz notes. Microwave therapy uses targeted thermal energy to heat and destroy damaged tissue, he says.

Utz uses Cooled ThermoTherapy, manufactured by Minneapolis-based Urologix. "By combining cooled fluid to cool the prostate and urethra, I can generate more energy to drive the heat deeper into the prostate to destroy damaged tissue," he explains. "Without the cooling component, I cannot use the same amount of heat without damaging the prostate and urethra."

Gregg R. Eure, MD, assistant professor of urology at Eastern Virginia Medical School in Virginia Beach, uses TherMatrx Dose Optimized Thermo-therapy system (Northbrook, IL) "because the different-sized catheters enable me to provide the correct dose of heat necessary to effectively and safely treat my patients. Over 30,000 treatments have been performed with this technology with no adverse events," he explains.

Side effects from microwave therapy are mild and don’t last long, Eure says. "Irritation while voiding, mild hematoma, and a very small chance of infection are the most common effects," he points out. The benefits of microwave therapy include a one-time treatment in an office rather than a hospital setting, the use of mild oral medications rather than narcotics or IV anesthesia, the ability to eliminate medication therapy, and relief of symptoms in most patients, he notes.

"Most patients are on medication therapy prior to receiving the microwave treatment, but we begin to taper them off the drugs three to four weeks after the procedure," Eure says.

Preliminary data from studies of patients who underwent the procedure five years ago show they are doing well, with no return of symptoms, he adds.

Training for either thermotherapy system is minimal, with both companies offering education for surgeons and staff members. "I do suggest that one person, either a medical assistant or technician, be assigned the responsibility as the microwave expert," says Eure. "This person can undergo training that will enable him or her to train others and become the office expert on this technology."

In early 2004, the Centers for Medicare & Medicaid broadened government reimbursement for BPH treatments in an office setting. The average reimbursement for BPH treatments performed in an urologist’s office is $4,084, according to a Urologix spokesperson.

Patients who choose microwave therapy are looking for a definitive and lasting treatment, says Utz. "We use topical anesthesia, and the treatment lasts less than 30 minutes," he says. Most patients report a discomfort level of a 1 on a scale of 1 to 10 with 10 representing the most pain or discomfort, he adds. Half of his patients leave with a catheter that stays in place for 48 hours, but there are no restrictions on activity, he says.

There are a few patients for whom microwave therapy is not recommended, Eure says. "Any time there is a concern about prostatic cancer, stricture disease, or an abnormality of the median lobe, this procedure should not be used," he says. Patients with these conditions are at risk for more serious side effects and should rely upon more traditional surgical or medication therapies, he adds.

Utz does point out that patients need to know that the therapy does not produce an immediate relief of symptoms. "Most patients see complete relief within six to eight weeks following therapy, and they enjoy that relief for many years, as we’ve seen in follow-up studies."1

Reference

1. Thalmann G, Mattei A, Treuthardt C, et al. Transure-thral microwave therapy in 200 patients with a minimum follow-up of 2 years: Urodynamic and clinical results. J Urol 2002; 167:2,496-2,502.

Sources and Resources

For more information, contact:

  • Gregg R. Eure, MD, Assistant Professor of Urology, Eastern Virginia Medical School, 1200 First Colonial Road, Suite 100G, Virginia Beach, VA 23451. E-mail: EuresVB@aol.com.
  • William J. Utz, MD, Chairman of the Urology Department, Abbott Northwestern Hospital, 6525 France Ave. S., Suite 200, Edina, MN 55435.

For more on microwave therapy systems, contact:

  • Urologix, 14405 21st Ave. N., Minneapolis, MN 55447. Phone: (763) 475-1400 or (800) 475-1403. Fax: (763) 475-1443. Web: www.urologix.com. Manufactures Cooled ThermoTherapy. A variety of pricing options that include outright purchase of the control unit for $40,000 or "per use" lease contracts that range from $1,200 to $1,600 per procedure for use of the control unit and disposables. The disposable procedure kit for customers who own their unit costs between $1,100 and $1,450 depending on volume ordered.
  • TherMatrx, 3675 Commercial Ave., Northbrook, IL 60062. Phone: (888) 677-8667. Fax: (847) 412-0066. Web: www.thermatrx.com. Manufactures Dose Optimized Thermotherapy. While actual costs may differ according to volume, list price for the system is $23,000 and list price for the disposable treatment catheter is $1,350.