Transurethral microwave therapy (TUMT)

Transurethral microwave therapy (TUMT) is a minimally invasive surgical procedure done for the prostate. It is used to treat benign prostate hyperplasia to reduce the symptoms that occur due to an enlarged prostate. This is used for individuals with life-threatening health conditions who are not eligible for more invasive surgeries. It uses a microwave antenna to destroy the enlarged tissue. 

Anatomy:

The prostate is a type of male reproductive organ located in the male's lower part of the pelvis. It is present between the penis and the urinary bladder. It looks like a cone and has five lobes. It produces fluid that keeps the sperm healthy. A prostate-specific antigen that plays an important in male fertility and the motility of the sperm is secreted by it. 

Benign prostate hyperplasia (BPH):

BPH is a condition of the prostate. It commonly affects the older age group. It causes an increase in the size of the prostate. This enlarged prostate can pressurize the urethra, narrowing it. This causes many symptoms like increased urge to urinate at night, increased frequency of urination, and inability to empty the bladder. 

Technique:

TUMT is a minimally invasive therapy for BPH. It works on the technique of using a temperature that exceeds the protein denaturation temperature. A small microwave antenna is inserted from the penis tip through the urethra to reach the prostate. A dose of microwave radiation is sent from the device in the form of heat. This heat denatures the prostate, which is causing pressure on the bladder. This relieves the pressure, allowing the free flow of urine. 

Indications:

TUMT is indicated in mild to moderate BPH. It is done to reduce the symptoms of BPH like increased frequency of urination, urge of urination, difficulty in starting to urinate, prolonged urination, increased frequency of nighttime peeing, discontinuous flow of pee, inability to empty the bladder, and frequent urinary tract infections. 

Contraindications:

TUMT is not indicated in conditions when an individual has a penile implant, narrowing of the urethra, median lobe disorders of the prostate, cardiac pacemakers, devices like defibrillators, and implants for hip replacement 

Advantages:

There are many advantages of TUIP.

• It is a very safe and minimally invasive method in men with small enlargements
• It has a low risk of bleeding and is safe in individuals who use blood thinners or who have bleeding disorder 
• It can be done as an outpatient procedure and needs less hospital stay 
• There is less incidence of the backflow of semen into the bladder during ejaculation
• This procedure has relatively fewer adverse effects due to the procedure
• It takes less time than any other surgical procedure for BPH
• Catheterization time is also less
• It is simple and cost-effective 

Before the procedure:

Before TUMT, it is important to understand the importance of the procedure by discussing it with the healthcare provider (HCP). Complete details regarding the medical, surgical, allergic, and medication history should be given to the HCP. Diet will be restricted and a list of medications to be stopped and another list of medicines to be used before the procedure will be given. One has to undergo certain blood tests to understand the current medical condition.

 Certain advanced imaging studies like MRI or CT are also done to assess the extent of the disease. TUMT will be done on an empty stomach under anesthesia. Hence, it is necessary to refrain from eating anything 8-12 hours before the procedure. Inform the healthcare provider of any previous allergies to anesthesia. 

During the procedure:

TUMT is done under general anesthesia, or it may be done under spinal anesthesia. Spinal anesthesia blocks the sensation and pain from below the waist. Local anesthesia to body parts like the urethra and prostate will be given to numb by a gel or an injection.

Using the ultrasound guidance, a catheter is sent through the penis tip that passes through the urethra to reach the prostate. The catheter has a microwave antenna attached to it. Temperature is monitored by a thermometer in the rectum. Balloons are connected to the antenna and the thermometer to keep them in place. Their position is confirmed by using the ultrasound. 

The antenna of the microwave generates heat to destroy the excess prostate tissue. Water circulates its tip to protect the adjacent structures. The heat generated is enough for the excess prostate tissue to be removed but not other parts. The duration of the treatment time depends on the HCP's preference and the type of machine used. 

During the procedure, heat is generated, which may cause mild discomfort and pain. The amount of heat is adjusted based on the individual's pain tolerance. 

After the procedure:

After the procedure, the individual is monitored till the vitals stabilize. Medications are given to reduce pain and ward off infection. About 1-3 days after the infection catheter is removed. One can resume normal activities in 3 days but should stay away from strenuous activities for at least two weeks after the procedure. One can have sex four weeks after the procedure. 

Effectiveness:

TUMT is an effective procedure in males with prostate enlargement as it can reduce the signs and symptoms of BPH. 

Side effects:

Some of the side effects include blood in the urine for a few days after the procedure. Frequent urge to urinate, burning sensation at the tip of the penis, and at the end of urination are some of the side effects. One may also experience a loss of control over the bladder for a few days. 

Risks and complications:

Certain risks associated with the procedure include recurrent urinary tract infections due to catheter placement, worsening of the symptoms, and recurrence of the symptoms needing another treatment. 

Conclusion:

TUMT is a safe and effective procedure for benign prostate hypertrophy. It works on the principle of heat generation by microwave therapy. It causes less difficulty, faster recovery, and improved quality of life. 

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