I had a TUMT.  It didn't work as I had a large median lobe.   Seven months
later I had a PVP and that worked great.

In my opinion, TUMT is a waste of time and effort now that PVP is widely
available.

Patrick

I had a TUMT almost 2 years ago, following several years of increasing BPH
symptoms (frequency, recurring urinary infections, and rising PSAs). An
immediate procedure was made necessary by the results of a an appendectomy,
when my bladder was allowed to overfill, became distended and could no
longer push my urine past the prostate easily. Luckily, I've never been
awakened by the urinary urge at night.  Now I wake myself once, just to help
keep my bladder in good shape.

My symptoms subsided significantly after the TUMT, but the prostate has now
grown back to even larger than it was before the TUMT (Uro says 170 grams,
believe it or not).  Biopsy was negative and symptoms are not significant at
all......... however a further procedure is inevitable.  My Uro says his
group is gaining access to PVP equipment this month, and he will consider a
procedure for me after they have some experience.

Had PVP been available 2 years ago, it would have been my only choice.

I have not looked at the prostate newsgroups for years, but decided to do so
tonight.  I saw Tony's request for replies from "TUMT survivors."

I don't know what a "TUMT survivor" is.  I had TUMT about five years ago and
was thrilled to be able to avoid TURP with its near-certain retrograde
ejaculation and high rate of negative outcomes.

I wrote up a report and posted it on the internet years ago.  It is below.

I'm very pleased with the results of my TUMT and would highly recommend the
procedure.  But.....as with any medical procedure the key is having a
knowledgeable, skilled urologist.  I did and had a great outcome.

By the way, I'm a retired real estate developer, age 63.

Gregg Smith
Salem, Oregon USA

(P.S. Some of the phone numbers, addresses, etc. below may have changed
since 1998.)

++++++++++

My Experience With Transurethral Microwave Thermotherapy (TUMT)

For men suffering from serious BPH (benign prostatic hyperplasia), or
prostatic obstruction, and facing the possibility of the surgical procedure
known as a TURP (transurethral resection of the prostate), I would like to
describe my experience with BPH and an obstructed bladder and how I

reached a decision to cancel a scheduled TURP and select a non-surgical

alternative therapy called a TUMT (transurethral microwave thermotherapy).

For approximately 18 years I had what my personal physician and my urologist
described as a 'moderately enlarged prostate.' I had symptoms of BPH, but I
was treating it successfully with the herb saw palmetto (which Merck
reportedly synthesized to create Proscar). I had more-frequent-than-normal
urination, low volume, a weak stream and occasional urgency, but I seldom
had to get up more than once at night to urinate. Things seemed under
control and I thought that perhaps in 15 - 20 years I would have to have
some sort of prostate procedure.

On November 13, 1997, I had major knee surgery under general anesthesia.
Anesthesia and narcotic-based, pain-killing drugs given to a patient during
and immediately after surgery may cause the prostate to swell and the
bladder's smooth muscle tissue to weaken. This is what happened in my case.
In the 48 hours following my knee surgery, my prostate swelled and
obstructed the bladder outlet. My bladder was too weak to push the rising
volume of urine past the prostatic obstruction and it became distended. I
went into retention (that is, I completely lost the ability to urinate) and
I had to be catheterized. I was placed on Cipro and Flomax (.8 mg). Over the
next month four separate attempts to come off the catheter were unsuccessful
and I was scheduled for a TURP on December 19, 1997.

I did not want a TURP because of the near-certainty of retrograde
ejaculation following surgery and the possibility, although admittedly
small, of impotence, incontinence, internal bleeding and strictures, the
latter two of which would require further surgery. However, I saw no
alternative to a TUPR other than wearing a catheter for the rest of my
life.

Days before my planned TURP I read a magazine article on new medical
technologies in Newsweek Extra, Winter 1997-98, page 78. The article
contained a reference to a new microwave technique for treating BPH. I
cancelled my TURP and got on the Internet. I downloaded a number of files
on what I came to understand was called a TUMT (transurethral microwave
thermotherapy). I discovered that this technique had been used in Europe and
Canada since 1990. In May, 1996, the FDA approved the first TUMT device for
use in the U.S., the Prostatron 2.0 protocol. The device is manufactured by

EDAP Technomed, Inc. of Norcross, Georgia, phone (770) 446-9950.

(see www.edaptechnomed.com.). The Prostatron 2.0 protocol is designed for

normal BPH. The Prostatron 2.5 protocol, approved by the FDA in November,

1997, is designed for serious obstruction cases, such as I had.

Through EDAP Technomed I identified a physician in Canada, Dr. Ronald

Sorensen, (phone: 800-668-8868) with several years experience using the

Prostatron, including 300 procedures with the 2.5 protocol. I was aware that

the 2.5 protocol would be available in the U.S. early in 1998, but I did not
want

to be the first patient through the gate as the new 2.5 protocol was
implemented

at a U.S. medical facility. I felt it best to obtain the treatment from
someone with

substantial experience in the specific protocol I needed. Consequently I
flew to

Canada and Dr. Sorensen performed the TUMT on me on January 18, 1998.

(Note: If I were to have a TUMT today, I would have it an a U.S. medical
facility

now that they have ample experience in both the 2.0 and the 2.5 protocols.)

The FDA has now approved two additional TUMT devices for use in the
U.S. They are the Urologix T3 / Targis system (see www.urologix.com),

and the Dornier Urowave system (see www.dornier.com). For FDA TUMT

approval information call (301) 594-2194.

Below is a comparison of the TURP with the TUMT. I have gleaned the data
from a number of sources. Don't hold me to any specific number since there
are a variety of studies with differing results. Nonetheless, the general
trend shown in the data seems reasonably accurate.

TURP:  General anesthesia or spinal anesthesia.
TUMT: Local anesthesia in urethra.

TURP:  Two - three days hospitalization for surgery and post-operative
recovery.
TUMT: Outpatient procedure - three hours for preparation, procedure and
recovery.

TURP:  Two or more weeks of inactivity following release from hospital.
TUMT: Resumption of normal activity the day following the procedure.

TURP:  Retrograde ejaculation: more than 90%
TUMT: Retrograde ejaculation: 2.0 protocol: 0%
                                                   2.5 protocol: 20%-40%

TURP:  Impotence: +/- 5%
TUMT: Impotence: 0%

TURP:  Incontinence: +/- 1%
TUMT: Incontinence: 0%

TURP:  Internal bleeding, serious, requiring intervention: +/- 4%
TUMT: Internal bleeding, minor, self limiting: 10%-20%

TURP:  Strictures: 4.5%-11%
TUMT: Strictures: 0%

TURP:  Post -TURP syndrome: +/- 2%
TUMT: Post-TUMT syndrome: N. A.

TURP:  Retreatment required: 12%-15%
TUMT: Retreatment required: less than 10%

I did not want to subject myself to any of the risk factors associated with
a TURP when a "TUMT produces subjective and objective improvements of BPH
symptoms in a comparable range to a TURP." Quoted from "High Energy
Thermotherapy versus Transurethral Resection in the Treatment of Benign
Prostatic Hyperplasia: Results of a Prospective Randomized Study with 1Year
Follow-up." Journal of Urology, 158:120-125, 1997. A synopsis of this
article and others may be found on the Internet at:
http://www.uroweb.org/literature/index.html.

A TUMT is not surgery. It uses a catheter inserted up the urethra to direct
microwaves into the center of the prostate gland killing a small number of
cells. As the dead cells collapse and are absorbed, the gland shrinks toward
its center, relieving pressure on the urethra. The shrinkage occurs
relatively

slowly, with maximum shrinkage being achieved around three months but

with symptoms sometimes improving for up to a year.

I had been catheterized for two months prior to my TUMT procedure. It was
also necessary for me to be re-catheterized following the procedure to allow
the swelling of the microwave-treated prostate to recede. I was instructed
to leave the catheter in for about two weeks. Out of superstition I chose
to go three weeks and removed the catheter on February 9, 1998, my 58th
birthday. (I believe catheterization after treatment with the 2.0 protocol
may be unnecessary in some cases, or only be necessary for a day or two.)
As soon as I removed the catheter I was able to urinate. I was ecstatic. It
was my first successful urination in three months. Over the next several
weeks

I experienced steady improvement in the strength and volume of my urination.

Following my TUMT I was advised that I might have to intermittently

self-catheterize after I removed the catheter. That proved to be my
experience
upon rising in the morning with a full bladder. The bladder fullness
apparently

put unfamiliar pressure on the system and caused urine flow to nearly cease.

However, I only had to self-catheterize upon rising the first two mornings
after

I removed the catheter. By the third morning I had a good flow. I was also

advised that after removing the catheter I should self-catheterize several
times

to do voiding tests. These tests were to ascertain the residual volume of
urine

in my bladder following urination. If the residual was over 200cc I was told
I

would need to intermittently self-catheterize during the day to keep the
volume

of urine in the bladder below 500cc. If the residual was under 100cc I was
told I could stop self-catheterizing. I tested three times after urination
and in

each case my residual was under 90cc, so I stopped self-catheterizing.

I experienced no pain following the TUMT, although in the 24 hours after

the procedure there were episodes when I felt extreme urgency to urinate.

This was the only discomfort I experienced. There was very minor bleeding

after the procedure, which tinged my urine a rosy color. This lasted for

several weeks and is normal.

At exactly two months after my TUMT my urinary flow weakened and the
frequency of urination increased. For a few days I was very concerned that
something was not right. One day I self-catheterized to check the residual
level in my bladder. I was relieved to find that it was minimal. I called my
Canadian urologist's staff and was told that this event was normal. When the
2.5 protocol is used on a serious obstruction, such as I had, the heat at
the center of the prostate gland reaches such a level that it kills cells as
far out as the urethra lining. As these cells die and are sloughed off,
they may obstruct the urethra somewhat and reduce urinary flow. I passed
small flecks of dead tissue for about one month. By three months after the
TUMT there was no more dead tissue in my urine and my urinary flow was
excellent.

My sexual performance has been normal, or actually improving several months
after the TUMT. I now produce seminal fluid upon ejaculation at four-to-five

times the volume as before the procedure.

In summary, I had a fully-obstructed bladder and had been catheterized for
two months prior to my TUMT. The new Prostatron 2.5 protocol was
specifically designed for cases like mine and it seems to have worked very
well. The cost seemed reasonable to me, but it will vary from place to
place. I paid $5,000 for my TUMT, of which my health insurance will cover

only a portion since this was an out-of-country procedure.

If you want a consider having a TUMT you will need to shop around for a

medical facility near you offering this service. Most U.S. urologists do not

yet have experience with the TUMT. Furthermore, some urologists may be

resistant to the TUMT.  The capital cost of the equipment and the necessity

for learning a new technology may cause some urologists to stick to what the

urology profession calls its "gold standard" - the TURP.  However, based on

my personal experience I would echo a second quote from the above-cited

article "High Energy Thermotherapy versus Transurethral Resection in the

Treatment of Benign Prostatic Hyperplasia etc." To wit:

"...looking...at the results presented by the authors, one might doubt that
TURP is a gold standard treatment for BPH. Indeed, with only 43% of patients
being improved both in flow and BPH symptoms and 78% when considered
symptoms only, we could be more cautious when stating unanimously that TURP,
even performed by experienced urologists as in this study, is unequivocally
the gold standard (maybe for the urologists, but not necessarily for the
patient...)."

I would be happy to correspond with any man interested in my personal
experience with a TUMT. If you wish to contact me, my e-mail address is:

mgreggsmith@attbi.com

One final note. There has been a lot of discussion about laser treatment of
BPH. I would say only one thing. Most lasers are just different kinds of
knives. They cut. Surgery may be necessary and appropriate for many men,
depending on their specific cases. However, I suggest any man considering
surgery ask a lot of questions, read everything available and explore all
the options. There is a great deal of information on the Internet on the
TUMT. Just put "TUMT" into your search engine and hit "search." Some
articles you may want to read are:

1. D'Ancona, FCH; Francisca, EAE; et al; "High Energy Thermotherapy versus
Transurethral Resection in the Treatment of Benign Prostatic
Hyperplasia: Results of a Prospective Randomized Study with 1 Year
Follow-up,"

Journal of Urology, 1997:158:120-125

2. Blute, M. and de Wildt, M; "Transurethral microwave thermotherapy for
BPH," Contemporary Urology,1996:8:10

3. Dahlstrand, C.; Geirsson, G.; et al; "Transurethral Microwave
Thermotherapy versus Transurethral Resection for Benign Prostatic
Hyperplasia:

Preliminary Results of a Randomized Study," European Urology,
1993:23:292-298

4. Oesterline, Joseph E., M.D., "Benign, Prostatic Hyperplasia, Medical and
Minimally Invasive Treatment Options," The New England Journal of Medicine,"

January 12, 1995, Vol. 332, No. 2.

5. Politis, G; Pardalidis, N; "Transurethral Microwave Thermotherapy (TUMT)
in Benign Prostatic Hyperplasia (BPH) Three Years Later," paper presented at
1996
EAU Congress in Paris, see Internet:
http://www.uroweb.org/posters/paris96/98/index.html

M. Gregg Smith
Salem, Oregon
November 8, 1998