For an understanding on how BPH affects so many men, please review the BPH page of this site.
For those patients that would like to be treated without medications, would like to get off medications, and do not want to go to the hospital to have anesthesia for a laser prostatectomy or are too sick to do so, microwave thermotherapy of the prostate is another excellent alternative. This is an in-office procedure that generally takes about 45 minutes to perform and is done with a local anesthetic and some very mild sedation with little to no discomfort.
Microwave therapy results in sustained improvement in urinary symptoms that last for 5 years or more (the newer systems that work well have not been around much longer than that). The improvement is not quite as dramatic as with a TURP or laser prostatectomy (see BPH page), but is better than with medications alone. The fact that it is a minimally invasive procedure that works better than medications is what attracts many men to this therapy. While results are generally good, 30 to 40 percent of men will have no improvement with this therapy. Laser prostatectomy, while a little more invasive, improves symptoms in over 90 percent of patients.
What tests need to be done prior to considering microwave therapy?
A complete evaluation by a urologist is, of course, necessary. This includes a complete history and physical, labaratory tests to ensure there is no uncontrolled diabetes or other medical problem that may be causing urinary symptoms, as well as a urinalysis to rule out a urinary tract infection. A PSA (prostate specific antigen, a blood test screening for prostate cancer) will be done to rule-out prostate cancer as a cause of symptoms.
If these tests are all normal, then a transrectal ultrasound is done to get an accurate measure of prostate size. Cystoscopy (look at the prostate and bladder with a small, flexible scope that is passed through the penis) is also performed to measure the length of the prostate so that the appropriate sized catheter can be used.
How is the procedure performed?
Prior to the procedure, we generally have you take some medications at home, including a pill to prevent bladder spasms, an antibiotic, and a mild sedative. Somebody needs to drive you to and from the office to have the procedure.
Another transrectal ultrasound is done so that a local anesthetic can be injected into the prostate. This involves little to no discomfort. A small rectal balloon temperature monitor is then placed. A small treatment catheter is then placed through the tip of the penis into the urethra and positioned with a balloon in the bladder, which is confirmed by a pelvic ultrasound.
The treatment is then undertaken and takes between 30 and 45 minutes. You will be watched closely during the procedure to ensure you are comfortable. There may be a feeling of needing to urinate, some pelvic pressure, and sometimes the heat can be felt. The vast majority of patients do well with minimal discomfort.
Once the procedure is finished, the treatment catheter is removed and a temporary catheter is placed. You will go home with this catheter. The catheter is then removed a few days later. Once the catheter is out, it generally takes 2 to 3 months for symptoms to improve. The microwave energy causes the prostate tissue to slowly die and eventually disappear, but this takes time.
Dr. Hendricks uses the most up-to-date microwave systems available. These systems work well for appropiately selected patients.
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