Radiofrequency heat-treatment to the prostate for bladder outlet obstruction associated with benign prostatic...

To evaluate the long-term effect on symptom relief and voiding performance of prostatic radiofrequency thermal treatment for bladder outlet obstruction (BOO) associated with benign prostatic enlargement (BPE).

During 1991-1994, 151 patients (mean age 76 years, range 49-91) with symptomatic BOO associated with BPE (i.e. reduced urinary flow rate and persistent residual urine) but with no clinical evidence of carcinoma of the prostate, were treated using the Thermex II (Direx, Israel) intraurethral radiofrequency (RF) prostatic thermal treatment system. This treatment rates the intraurethral temperature to 48 degrees C for 3 h in a single session under local anaesthesia. The patients were followed using symptom scores and uroflowmetry for 24-48 months after treatment.

At 1 year, 70% had a good outcome, but by 3 years this had fallen to 40% and at 4 years to 22%. An increase in mean urinary flow rate, from 9 to 12 mL/s, was sustained throughout the follow-up. There was a reduction in mean residual urine from 83 to 51 mL at 6 months, but this increased to 70 mL by 3 years (not significant). The voiding pressure, which declined at 6-12 months, increased again to near pre-treatment values at 1-2 years.

In patients with symptomatic BPE, prostatic thermal treatment with RF relieves symptoms in 60% for at least 2-3 years. In selected cases it is a useful form of management, as it can be performed as a day-case with minimal risk. Changes in standard objective variables were small but statistically significant for at least one year. The study highlights the importance of waiting for late results from clinical trials.