Saitz Theodore R, Conlin Michael J, Tessier Christopher D, Hatch Thomas R
Oregon Health and Science University, Portland, USA.
Veterans Affairs Portland Health Care System, Portland, USA.
Turk J Urol. 2018 Nov 19;45(1):27-30. doi: 10.5152/tud.2018.09622. Print 2019 Nov.
Previous studies have demonstrated the efficacy of transurethral microwave therapy (TUMT) in the management of high-risk catheter-dependent men, although few have assessed safety in high-risk patients, including those continuing anticoagulation therapy during treatment. Our goal was to assess the safety and effectiveness of TUMT in a population of high-risk catheter-dependent men.
A retrospective analysis of patients who underwent TUMT at a single Veterans Affairs facility for the treatment of benign prostatic hyperplasia was completed. The primary outcome was 30-day postprocedural complications by Clavien-Dindo grade, including bleeding events. The secondary outcome was success in catheter removal.
We performed TUMT in 157 men, 105 of whom had urinary retention-requiring an indwelling urethral catheter or clean intermittent catheterization. Overall, 86% of patients underwent TUMT while on anticoagulant therapy and 25% were treated while taking warfarin. The median age of the patients was 76.9 years (95% CI 74.9-78.8) median ASA-score was 3, and median follow-up was 26 months (range 1-65). Only two men experienced hematuria requiring treatment postoperatively and no transfusions were required. Only two patients (1.9%) required readmission within 30 days after treatment. There were 24 (22.9%) Clavien-Dindo grade I-II complications without grade III or higher complications. Urinary retention resolved in 63.7% of men after treatment.
Our results suggest that TUMT is a safe and reasonably effective treatment for high-risk catheter-dependent men. Furthermore, the low incidence of adverse bleeding events suggests that TUMT is a safe treatment modality for men requiring uninterrupted anticoagulation.
既往研究已证明经尿道微波治疗（TUMT）对高危依赖导尿管男性患者的有效性，不过很少有研究评估高危患者的安全性，包括在治疗期间继续接受抗凝治疗的患者。我们的目标是评估TUMT在高危依赖导尿管男性患者群体中的安全性和有效性。
对在单一退伍军人事务机构接受TUMT治疗良性前列腺增生的患者进行了回顾性分析。主要结局是根据Clavien-Dindo分级的术后30天并发症，包括出血事件。次要结局是成功拔除导尿管。
我们对157名男性进行了TUMT，其中105名有尿潴留，需要留置尿道导尿管或清洁间歇性导尿。总体而言，86%的患者在接受抗凝治疗时接受了TUMT，25%的患者在服用华法林时接受了治疗。患者的中位年龄为76.9岁（95%CI 74.9 - 78.8），中位ASA评分是3，中位随访时间为26个月（范围1 - 65个月）。只有两名男性术后出现需要治疗的血尿，且无需输血。只有两名患者（1.9%）在治疗后30天内需要再次入院。有24例（22.9%）Clavien-Dindo I-II级并发症，无III级或更高级别并发症。治疗后63.7%的男性尿潴留得到缓解。
我们的结果表明，TUMT对于高危依赖导尿管男性患者是一种安全且相当有效的治疗方法。此外，不良出血事件的低发生率表明TUMT对于需要不间断抗凝治疗的男性是一种安全的治疗方式。
