TUMT (Trans Urethral Microwave Thermal Therapy)
The TUMT is a minimally invasive prostate procedure typically office-based, although they are occasionally performed in a hospital or surgical center. These procedures are performed to treat bladder outlet obstruction due to benign prostatic hyperplasia (BPH). With progressive BPH, the prostate enlarges and obstructs the proper flow of urine from the bladder.
Most often, the reduced flow represents a combination of prostate enlargement and tone (the prostate constricting down on the urethra as the urethra courses through the center of the prostate). Patients with this condition may have been on one or a combination of medications prior to needing a procedure.
If the medications are no longer effective in alleviating symptoms, then a TUMT or other procedure may be warranted. Sometimes the medications are effective, but side-effects prohibit their use in a particular patient. In other instances, the symptoms are tolerable, but we have determined that the degree of obstruction is progressively damaging your bladder and perhaps even your kidney.
Symptoms of Obstructive Urination Patterns
The characteristic symptoms are those of an obstructive urination pattern and are most commonly recognized as:
- Straining (need to push to begin urination)
- Hesitancy (delayed onset of urination following the urge to urinate)
- Slow or diminished force of stream
- Intermittence (urine streatm that starts and stops)
- A sensation of incomplete empyting of your bladder
Other symptoms that may be associated are what we call irritative symptoms and include: frequency of urination, the urgency to urinate, and nocturia (getting up at night to urinate).
What to Expect During the Procedure
The TUMT procedure usually can be done with local anesthesia, sedation (light twilight sleep), or a combination of the two. With the TUMT, the energy form used causes destructive changes in the tissue that result in a more gradual (perhaps weeks to months) ablation or reduction in the blocking prostate tissue.
The actual procedure usually takes less than one hour. You will be placed flat on your back. Many urologists use a combination of numbing jelly and a mild sedative (either a pill or an intravenous injection). The TUMT involves placing a specially engineered catheter through the urethra and into the bladder. This catheter will be advanced up to a specific spot in the bladder so the active treatment zone of the catheter lies within the prostatic urethra (that portion of your urethra that is directly surrounded by your prostate).
A second smaller instrument is placed into the rectum and serves to monitor the temperature inside the rectum as the treatment catheter is heating. The treatment is then administered and computers are used to record the effects of the microwave heat on the prostate tissue.
At the end of the treatment, a urinary catheter may be placed into the bladder and attached to a small bag. This catheter may remain for a week (rarely more) or less to allow resolution of the anticipated swelling of the prostate. You will be given specific instructions on how to manage the catheter and empty the drainage bag. In some patients, the catheter will remain in for a longer period if urination continues to be difficult. In certain microwave procedures, a catheter is not always necessary, and you may be sent home without a catheter.
Expectations of Outcomes
Patients are usually satisfied after the procedure. The improvements that are typically noted after the operation takes full effect are:
- Stronger force of stream
- Decreased wait time for the urination to commence
- Decreased need to push
- Loss of intermittence
- Loss of the sensation that you are “not really emptying your bladder”