High-energy transurethral thermotherapy with CoreTherm approaches transurethral prostate resection in outcome efficacy: A meta-analysis

Background and Purpose: Minimally invasive office-based treatments for benign prostatic hyperplasia (BPH) are challenging the traditional surgical and medical management options for symptomatic BPH. We conducted a meta-analysis of published randomized controlled trials that compared high-energy transurethral microwave thermotherapy (HE-TUMT) with transurethral resection of the prostate (TURP) to compare subjective and objective outcomes. Materials and Methods: A literature search using Pub-Med was conducted to obtain all published data on HE-TUMT and all randomized controlled trials that compared HE-TUMT with TURP. Data were analyzed focusing on the pretreatment and posttreatment end points of the International Prostate Symptom Score(IPSS), maximum flow rate (Q _max), and postvoid residual (PVR). A meta-analysis was conducted, and data were stratified with respect to the type of HE-TUMT machinery used. Results: A total of 458 patients were studied. Differences in IPSS, Q _max, and PVR from current trials that compared TURP with HE-TUMT are best evaluated at 1-year follow-up. At this time point, changes in Q _max (P < 0.001), IPSS (P = 0.01), and PVR (P = 0.02) are more significant if TURP is the management mode. HE-TUMT with the CoreTherm™ device demonstrates the most significant improvements in subjective and objective criteria that approximate outcomes with TURP (Figs. 1-3). Conclusions: A meta-analysis of current randomized controlled trials that compared TURP with HE-TUMT demonstrates more significant changes in Q_max, IPSS, and PVR when TURP is used to manage symptomatic BPH. Despite these statistical differences, stratified data demonstrate that current HE-TUMT machinery is more effective than previously used lower-energy machinery, especially at objective end points. This is most evident when the CoreTherm device is used. These findings, coupled with the decreased costs and morbidity associated with HE-TUMT, support this treatment as a reasonable alternative to TURP.