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Objective: To investigate if 30-Minutes-TUMT was useful and safe in the treatment of chronic urinary retention due to BOO in patients with ASA II-III-IV., Material and Methods: 19 patients with chronic urinary retention (mean age 73.5 years) were scheduled for TUMT treatment because of absolute or relative contraindications to surgery. According to ASA classification there were 8 patients ASA II, 9 ASA III and 2 ASA IV. Routinely parameters were studied before and after treatment. Pain and patient's discomfort before, during and after TUMT treatment were registered using the VAS score (visual analogue scale: 0 = no pain and 10 = maximal pain). Urgency, irritation, and "how they feel" were registered at 2 days, 1, 2 and 4 weeks after TUMT using VAS technique., Results: Mean follow-up was 31,6 months (range 24-47), among the 9 responders patients (47.4%) who void normally without need of catheterisation, one patient died 12 months after the treatment for reasons not connected to the TUMT. Six patients (21.6%) failed the treatment and underwent TURP one or two years later (5 were ASA II and one ASA III). Among the 4 of 19 (21.0%) who had intermittent catheterisation after the treatment two died 1 and 2 years later, one has detrusor instability and one continued intermittent catheterisation. VAS during treatment was: 0 minute = 0.0; 5' = 3.1; 15' = 2.9; 25' = 2.8; 2 h after the treatment = 0.3. At 3 years follow up IPSS, QoL and Qmax were still acceptable. No major complication occurred., Conclusions: 47.4% of the patients responded positively to the new 30 minutes TUMT removing the urethral catheter, without needing surgical procedure avoiding the operation risk. 68.4% also improved their QoL. Local anaesthesia and oral/intravenous analgesia were sufficient during treatment. TUMT seems to have no anesthesiological risk. It is an option in patients with high risk of operation.

Objectives: Bladder-scan before uroflowmetry is useful to reduce non-evaluable Q(max)-data. A significant problem is to receive an adequate voided volume in uroflow-measurements. Aims of this study were 1--to confirm if pre-voiding bladder scan can reduce the number of inadequate flow measurements, 2--to establish threshold values for prevoiding bladderscan volumes before and after different treatments options 3--to study if it is possible to predict the post-residual voided volume., Material and Methods: 121 patients performed 2 uroflowmetry before and after different treatments. Bladder volume was measured by transabdominal ultrasound when the patient had the sensation to void and after uroflowmetry to calculate residual urine. Same investigations were repeated after different treatments., Results: 21% of the patients had insufficient voided volume < 125 ml in 1st recording and 22% in 2nd; while 28% of the patient had a volume voided < 150 ml in 1st recording and 33% in 2nd. There was a strong correlation between the pre-voiding measured volume and the voided volume (r = 0.801, p < 0.0001), linear regression analysis yielded 1st flow rate recording is Void-Vol = 32.703 + (0.637 * Pre-Vol) and 2nd flow rate recording is Void-Vol = 16.264 + (0.704 * Pre-Vol) (r = 0.855; p < 0.0001)., Conclusions: Bladder scanning before uroflowmetry reduces the number of non-evaluable Q(max) data. If a voided volumes of > 125 ml (> 150 ml) is required a mandatory pre-voiding bladder scan volume should be > 200 ml (> 250 ml), so non elegible Q(max) recordings will decrease from 21% to 5.8% (28% to 4.1%) in BPH patients who will undergo treatment and from 22% to 7.4% (33% to 5.8%) in BPH-treated patients. There is a difference between patients before and after treatment. It is not possible to predict the post residual voided volume by the bladder scan using the virtual calculation.

Aims: To evaluate the long-term outcome of transurethral resection of the prostate (TURP) and transurethral microwave thermotherapy (TUMT) in men with symptomatic benign prostatic hyperplasia (BPH), when allocation to the treatment-group was based on urodynamic diagnosis of bladder outlet obstruction (BOO)., Methods: A total of 231 elderly men with symptomatic BPH were treated either by TURP or by low-energy TUMT. A pressure-flow study was performed to detect the obstruction and to help in the selection of the two treatments. The patients were examined at baseline then checked again after 2 and 8 years., Results: At 2 years of follow-up there was a significant improvement for both IPSS and QoL (P < 0.0001) in both groups of treatment. This was accompanied by a significant improvement (P < 0.0001) in the maximum flow rate from 10.0 (5.8) to 16.4 (7.6) in the TURP group and from 12.1 (5.2) to 14.9 (5.7) in the TUMT group. These findings persisted at 8 years, they were, however, more pronounced after TURP. The overall retreatment rate reached a value of 11% in the TURP group and 27% in the TUMT group, respectively. At the follow-up, 95% of the patients who underwent TURP and 70% of the patients treated by TUMT claimed to be satisfied with that choice., Conclusions: With durable symptomatic improvement and lowest retreatment rate, TURP still presents a standard treatment option for patients with severe BOO. Low-energy TUMT has sufficiently relieved patients' symptoms and can be offered to less obstructed patients as an alternative.

Purpose: To evaluate the durability of the effect of transurethral microwave thermotherapy (TUMT) for lower urinary-tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO)., Patients and Methods: A total of 841 patients with LUTS received TUMT using the Prostatron device at Sahlgrenska University Hospital, Sweden. Two treatment programs were used: low-energy Program 2.0 and high-energy Program 3.5. A questionnaire, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, and questions about general health status, was sent to all the patients. The mean followup after TUMT was 8.8 years for Program 2.0 and 2.5 years for Program 3.5., Results: At the end of follow-up, 67% of the patients treated with Program 2.0 were satisfied with the TUMT. During the follow-up period, 37% of patients experienced worsened symptoms, 18% various complications (e.g., hematuria), and 25% transient urinary-tract infection, and 16% went into retention. Secondary treatment (repeat TUMT, transurethral resection, medical therapy) was needed in 32% of patients. The mean IPSS was 13.5, and QoL score decreased to 2.1. With Program 3.5, 82% of the patients were satisfied, with another 17% having increased symptoms, 17% various complication, 25% urinary tract infection, and 26% retention. Only 7% of patients needed secondary treatment. The IPSS and QoL score went down to 11.4 and 1.6, respectively., Conclusion: These long-term data show that TUMT produces durable improvement and, with its safety and low retreatment rate, presents an attractive alternative for patients with LUTS suggestive of BOO.

Objectives: To detect obstruction in patients with LUTS suggestive of BPH comparing the prostatic intravesical protrusion detected by abdominal ultrasounds with uroflowmetry testing results with urodynamic study to make evidence of obstruction., Material and Methods: A series of 25 patients (mean age 67.9 years) at the first visit for BPH problems, underwent to routine examination including: abdominal ultrasound examination, TRUS, uroflowmetry IPSS and QoL questionnaires and urodynamic evaluation. We evaluated the degree in mm of prostatic intravesical protrusion by ultrasounds with a bladder volume between 150-220 cc. The degree of protrusion was classified as mild (<5 mm), moderate (5-10 mm) and severe (>10 mm), Qmax was divided in obstructed (<10 ml/s), equivocal (10-15 ml/s) and unobstructed (>15 ml/s). Confirmation or not of obstruction was validated by urodynamic study., Results: mean prostate volume was 41.4cc; IPSS 22.4; Quality of Life 4.0; post voided residual urine 97.8 cc; DAMPF 62.6; Schäfer 3.4; Qmax 9.9 ml/s. Almost all the patients with severe protrusion had obstructed flow confirmed by P/F study. Patients with severe protrusion and unobstructedflow have obstruction compensated by high pressure voiding., Conclusions: These results, despite of the numbers of patients, suggest that the degree of prostatic protrusion measured by abdominal ultrasounds is a data that, if correlated to obstructed Qmax, can be used in the evaluation of BPH patients and their grade of obstruction.