Minimally invasive therapies are non-surgical treatments, performed in a one-time session. These procedures aim at reducing the tissue that blocks the urethra by using energy and heat inside the prostate (thermal ablation). The treatment session usually takes less than an hour, but the exact length of the treatment depends on the type of energy and method used.
In the past, when drug treatments were insufficient in reducing symptoms and improving uroflow (approximately 1 patient out of 5), the only alternative was surgery. Because of the potential complications and possible side effects of surgery, as well as the length of the hospital stay required for patients undergoing a surgical procedure, physicians have developed alternative therapies. Today, urologists can offer you a range of safe and effective Minimally Invasive Therapies (MITs). In contrast to surgery (Transurethral Resection of the Prostate - TURP) where prostatic tissue is cut away, MITs are therapies performed through the urethra (transurethral) without any cutting involved.
MIT procedures limit most of the risks associated with a surgical procedure: bleeding during the operation, fluid absorption (TURP syndrome), retrograde ejaculation, impotence and incontinence. The base principle of MITs is to shrink the tissue that obstructs the urethra. This can be done by using different sources of energy and methods, as listed below.
The therapies listed in this section are those reported in the World Health Organization (WHO) 2000 Report on Interventional Therapy for Benign Prostatic Hyperplasia Committee 10. The reports issued by the WHO represent the latest best practice recommendations in medicine.
1 - Transurethral Needle Ablation (TUNA) Therapy uses low-level Radio Frequency
Transurethral Needle Ablation (TUNA) uses precisely targeted low-level radio-frequency energy to shrink (ablate) enlarged and obstructive prostate tissue. This energy is delivered directly into the prostate via a tubular device (cystoscope) that allows the doctor to see into the urethra and perform the procedure. The low-level radio-frequency energy heats the obstructive tissue of the prostate, leaving the urethra and the rest of the prostate intact. This relieves the constriction of the urethra and improves symptoms of BPH. The procedure is done under general anaesthesia in hospital, usually as a day patient and is well tolerated. After the procedure, the patient is given fluids to drink and will be asked to remain in the clinic until he urinates. Patients are able to return to many of their normal activities within 24 hours. Symptomatic relief normally occurs after 2 to 6 weeks. Uroflow improvements can be seen after 3 to 6 months. Clinical data shows that the TUNA procedure has solid durability over 5 years. The great majority of the patients are satisfied with the relief of their BPH symptoms.
The treatment takes less than half an hour, and in most cases, a urinary catheter is not required. If required, the patient will keep the urinary catheter for 1 to 3 days. This procedure is intended for men over 50 with prostatic sizes of 20-50 cubic centimeters. TUNA Therapy is a one-time, non-surgical treatment associated with few side effects and complications (Journal of Urology 1998;159:1588-1594).
TUNA Therapy is based on a technology (thermal ablation by radio frequency) that has been used for many years in other medical domains such as cardiology and neurosurgery.
2 - Transurethral Microwave Therapy (TUMT) uses Microwave energy
Transurethral Microwave Therapy (TUMT) uses high temperatures of more than 55°C to heat the obstructive prostate tissue. Microwave energy is delivered through a soft transurethral device, consisting of a microwave antenna and an inflatable balloon that positions the heating device at the bladder neck. An optical-fiber temperature sensor measures the temperatures in the urethra. The procedure is a one-time treatment and takes half an hour. The patient may have to keep a urinary catheter for 2 to 3 weeks. This can result in higher rates of urinary tract infection. Sometimes, it is necessary to cool the rectum after the procedure in order to prevent complications.
The procedure is generally done under local or spinal anaesthesia in the urologist’s clinic and is well tolerated. After the procedure, a urinary catheter is needed for about two weeks. Patients are able to return to many of their normal activities within a few weeks. Symptomatic relief normally occurs after a few months.
3 - Interstitial Laser Coagulation (ILC) uses Laser energy
Laser energy coagulates the obstructing tissue of the enlarged prostate gland. The tissue that is destroyed is absorbed by the body and BPH symptoms decrease over time. The procedure takes less than 1 hour. The patient may have to keep a urinary catheter (catherisation) for 5 to 14 days. This can result in higher rates of urinary tract infection.
The procedure is generally done under local anaesthesia in the urologist’s clinic and is well tolerated. Patients are able to return to many of their normal activities after a few weeks. Symptomatic relief normally occurs after a few months.
4 - Transurethral Water-Induced Thermotherapy (WIT)
Transurethral Water-induced thermotherapy (WIT) is performed through a catheter with a positioning balloon that inflates to compress the urethra and stay in place during the procedure. Water heated to 60°C is circulated through the catheter and balloon for 45 minutes, transferring heat to the prostate. Local anesthesia is usually sufficient, and it can be done in an office setting. The need for a catheter after the procedure is low. The long-term durability of the treatment is not known. In the latest International Consultation on BPH, WIT is classified as a therapy under “investigation” and therefore not yet accepted as standard clinical practice.
More information on minimally invasive therapies can be found on the References section of this website.