Surgery and Medical Treatments
Transurethral Microwave Thermotherapy (TUMT)
Medically reviewed by Dr. Paul Song M.D
The transurethral microwave thermotherapy (TUMT) procedure is a treatment for men with urinary and pain symptoms from chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) that have not responded to other forms of treatment for three to six months. TUMT is a relatively noninvasive procedure that does not have a lot of post-operative side effects.
Doctors have not begun recommending TUMT as a common therapy for CP/CPPS, but its use is growing for the more difficult cases. If you have been suffering greatly from prostatitis and you are not getting results from trying multiple conventional, natural, and alternative treatments, you might consider discussing the TUMT procedure with your urologist.
The University Hospital Antwerp in Belgium did a study of 11 men who failed to respond to a wide variety of more conventional treatments. The men all went through a TUMT procedure and after two years, 88% of the patients were symptom free.
This procedure is sometimes used to treat a different prostate condition called enlarged prostate (benign prostatic hyperplasia, or BPH). Even though microwave therapy does not cure BPH, it reduces urinary frequency, urgency, straining, and intermittent flow, which can be symptoms that some men with CP/CPPS also have. Unlike TUNA and TURP, TUMT does not correct the problem of incomplete emptying of the bladder, which is a common symptom of BPH that is not generally associated with prostatitis. That is why TUMT may not as good an option for people with BPH, but it may be a valid surgical option for men with prostatitis.
A study involving 42 patients evaluated the side effects, tolerability, and efficacy of transurethral microwave thermotherapy with urethral cooling (cooled TUMT) for CP/CPPS. Cooled TUMT is an established treatment option for benign prostatic hyperplasia (BPH) that has minimal side effects.
The men all had CP/CPPS for more than three of the six months before receiving TUMT. Their National Institutes of Health-Chronic Prostatitis Symptom Index [NIH-CPSI] pain score was at least 8. Patients were randomized to receive cooled TUMT at an intraprostatic temperature of either approximately 55 degrees C (°C) or approximately 70°C. Researchers measured tolerability, side effects, and efficacy using standard diagnostic tests, including the NIH-CPSI. There was a subgroup analysis performed to evaluate the effects on patients both with and without BPH.
Thirty-nine patients successfully completed treatment, and 35 completed follow-up through 12 months. The baseline versus 12-month mean NIH-CPSI score had an improvement in mean value of 51%. The pain score improvement in mean value was 60%). The quality-of-life impact score improvement was 47%, and the urinary score improvement in mean value was 34%. Two patients had reduced sperm motility. Side effects were minimal and transient, resolved spontaneously or with medication, and were similar regardless of treatment temperature or whether the patient also had BPH comorbidity.
Researchers concluded that cooled TUMT appears to be promising for intractable chronic prostatitis with or without BPH. Longer follow-up and a larger trial are required to further evaluate the impact on fertility and longer-term durability.
What Does Transurethral Microwave Thermotherapy (TUMT) Involve?
The TUMT procedure is an outpatient procedure, which mean that you can go home the day of the procedure. It usually takes about an hour and does not require general anesthesia. Your doctor will give you a local anesthetic to numb the prostate area. This anesthetic may be inserted through the penis, or it may be administered via shot in the rectum or the perineum, which is the space between the anus and scrotum. You will probably receive an intravenous (IV) sedation, which will make you drowsy but conscious during the procedure. Your doctor will give you some pain medication as well.
With the TUMT procedure, the doctor will insert a catheter into your urethra. You will also have a thermometer inserted in your rectum for checking temperature. Both of these devices have balloons to hold them in place. Your doctor may use ultrasound to check the placement of these devices.
The catheter has a microwave antenna that causes enough heat to destroy portions of prostate tissue that are blocking urine flow. The selected portions are heated to at least 111 degrees Fahrenheit (°F). A cooling system protects the urinary tract during the procedure. You will feel some heat and discomfort in the prostate and bladder. You may also feel bladder spasms during the procedure and feel like you have to urinate. It is important to stay still during the procedure.
When the procedure is over, you may have a catheter inserted in your penis that goes to the bladder. This tube allows you to pass urine until you can urinate. Even though you can go home after the procedure, you will need to arrange a ride home because you will not be able to drive. You should avoid heavy lifting and any strenuous activity for about three to five days. Ask your doctor when you can resume sexual activity. Most men can resume having sex about two weeks after having TUMT.
What Are the Side Effects of TUMT?
The side effects of TUMT include blood in the urine for a few days after the procedure and urinary symptoms such as painful urination, difficulty urinating, frequent urination, or the sudden urge to urinate. The urinary symptoms should get better after a few weeks. More serious risks can include urinary tract infection and narrowing of the bladder neck or urethra (stricture), which can make urination more difficult.
The TUMT procedure has not been reported to lead to erectile dysfunction or incontinence, but it can lead to retrograde ejaculation. Also called dry orgasm, retrograde ejaculation occurs when the semen released during orgasm enters the bladder rather than leaving the body through the penis. This can affect your fertility.
You should start to see a noticeable improvement in your CP/CPPS urinary symptoms in several weeks to several months. It takes this long because it takes some time for your body to break down and absorb the tissue destroyed by the TUMT microwave energy.
If you have a penile implant, a urethral stricture, or have had radiation in the pelvic area, then TUMT is not recommended because of risk of complications.
Reference for TUMT:
Kastner C. et al. Cooled transurethral microwave thermotherapy for intractable chronic prostatitis–results of a pilot study after 1 year. Urology. 2004 Dec;64(6):1149-54.