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Am Fam Physician. 2001;63(2):362-364

Nearly 80 percent of men will develop benign prostatic hypertrophy (BPH) in their lifetime, and approximately 30 percent will undergo surgical intervention. Surgical intervention consisting of transurethral resection of the prostate for BPH is costly, invasive and associated with complications. Because BPH is associated with advancing age, a significant number of men with BPH have comorbidities that preclude surgical intervention. Thermo-therapy may be a useful alternative to surgery and is associated with fewer complications. Water-induced thermotherapy provides a novel approach to treatment of BPH. This procedure can be performed in the outpatient setting with topical anesthesia. Corica and colleagues studied the safety and effectiveness of hot water–induced thermoablation in the treatment of symptomatic BPH.

Patients who participated in the study were men who had elected to undergo prostatic surgery to treat symptomatic lower urinary tract symptoms related to BPH or adenocarcinoma. The patients were randomly assigned to receive one of four treatment protocols with water-induced thermoablation. The only anesthesia used was topical lidocaine gel. The patients and an observer rated discomfort during the procedure. The prostates were subsequently enucleated or removed and examined by a pathologist.

During the procedure, the patients reported mild discomfort. The most common complaint was distal penile burning. The complaints did not correlate with the extent of necrosis, balloon diameter or water temperature. All patients who had an indwelling Foley catheter were successfully voiding within 12 days after the procedure. The extent of necrosis after treatment was similar in all of the treatment groups with regard to water temperature. However, balloon diameter did correlate with the depth of necrosis.

The authors conclude that water-induced thermotherapy in patients with BPH produced consistent and reproducible periurethral necrosis. The procedure was well tolerated with minimal discomfort. The authors state that ongoing prospective studies need to be performed to establish the role of this therapy in the management of BPH.

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