Nonablative minimally invasive thermal therapies in the treatment of symptomatic benign prostatic hyperplasia

As all new treatment modalities nonablative thermal therapy for minimal invasive treatment of benign prostatic hyperplasia should be critically analyzed. This review discusses the literature to identify the merits of these so-called minimally invasive treatments and the place they should take in the armamentarium of benign prostatic hyperplasia therapy options.

In this review we analyze the different techniques and clinical studies of hot water induced thermotherapy, transurethral microwave thermotherapy, transurethral needle ablation and high intensity focused ultrasound. The high intensity focused ultrasound treatment is noninvasive, but due to the poor clinical results in benign prostatic hyperplasia and its need for anesthesia, this therapeutic option shifted towards the selective ablation of prostate cancer. The transurethral needle ablation treatment can be performed in an outpatient setting although most centers do not. The treatment is not suitable for the bigger prostates and therefore narrows its indication. Water induced thermotherapy is a very promising therapy, although without comparative studies a justified positioning remains difficult.

Of all nonablative thermal therapies, transurethral microwave thermotherapy is the best documented and with several randomized studies comparing transurethral microwave thermotherapy to surgical treatments of the prostate, this therapy definitively found its place as a serious alternative to the ablative surgical treatment options.