Transurethral microwave therapy (TUMT) is an outpatient procedure to treat urinary symptoms caused by an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH).It's used less often now than it was in the past and has generally been replaced by newer treatments.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). Your doctor extends the antenna until it reaches the area of the urethra surrounded by the prostate. The antenna emits 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 right 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.
TUMT is a treatment to ease urinary symptoms and complications resulting from blocked urine flow, generally from smaller, highly selected prostate patients, such as:
- 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 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 surgical methods, such as transurethral resection of the prostate (TURP), HoLEP and open simple prostatectomy. It may take some time, from weeks to months, to see the results of the procedure.
However, TUMT has several advantages over surgery:
- It can be done on an outpatient basis, so an overnight hospital stay isn't necessary.
- It doesn't require general or spinal anesthesia.
- It has a lower risk of causing heavy bleeding.
- It's less likely to cause erectile dysfunction or other sexual side effects.
- It's an option for men who need to avoid surgery because of other health problems.
Risks of TUMT include:
- Urinary retention. You may have trouble urinating for a few days after the procedure. Until you can urinate on your own, you will need to have a tube (catheter) inserted into your penis to carry urine out of your bladder.
- 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.
- Need for retreatment. Most men who have TUMT will 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
- Urethral stricture — narrowing of urethra
- Radiation treatments in the pelvic area
Before the procedure, your doctor may want to do a test that uses a 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 specifically measure the prostate or urine flow.
Follow your doctor's instructions on what to do before your treatment. Here are some issues to discuss with your doctor:
- Your medications. Tell your doctor about any prescription, over-the-counter or supplements you take. This is especially important if you take blood-thinning medications, such as warfarin (Coumadin) or clopidogrel (Plavix), and nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others).
- Fasting 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.
- Arrangements after the procedure. You won't be able to drive yourself home after the procedure, so you'll need to arrange for someone to drive you home.
- Activity restrictions. Your doctor will likely ask you to avoid any strenuous activity, such as heavy lifting, for three to five days after the procedure. You should also wait to have sex until your doctor says it's OK. Most men can resume sexual activity about two weeks following the procedure
TUMT takes about 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
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 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 (Foley 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.
Short-term side effects of TUMT can include:
- Blood in your urine (hematuria). This shouldn't last more than a few days after the procedure.
- Irritating urinary symptoms. You may experience painful urination, difficulty urinating, or an urgent or frequent need to urinate. These symptoms usually improve within a few weeks.
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.
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. Some men need retreatment in time.
July 23, 2013
- Wein AJ, et al. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/das/book/body/208746819-6/0/1445/0.html. Accessed April 11, 2013.
- Management of benign prostatic hyperplasia (BPH). American Urological Association. http://www.auanet.org. Accessed April 11, 2013.
- 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. Accessed April 11, 2013.
- Update on AUA guideline on the management of benign prostatic hyperplasia. Journal of Urology. 2011;185:1793.
- Preparing for your operation and recovery. American College of Surgeons. http://www.facs.org/patienteducation/surgery.html. Accessed April 11, 2013.
- Prostate enlargement: Benign prostatic hyperplasia. National Institute of Diabetes and Digestive and Kidney Diseases. http://kidney.niddk.nih.gov/KUDiseases/pubs/prostateenlargement/index.aspx. Accessed April 11, 2013.
- Hoffman RM et al. Microwave thermotherapy for benign prostatic hyperplasia. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004135.pub3/abstract. Accessed April 26, 2013.