Complications

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Overall

Although relatively safe, TUMT is associated with a number of complications, and a variety of other rare but reported complications may occur. This includes, but is not limited to, urethrorectal fistula, bladder perforation, and emphysematous prostatic abscess (25,26). Proper monitoring by both physicians and nurses during treatment and accurate catheter placement are vital to decrease these risks.

Complications Compared with TURP

TUMT and TURP are associated with a similar complication rate, although the types of complications differ. Acute urinary retention and postoperative voiding dysfunction are more common after TUMT, and bleeding, retrograde ejaculation, and urethral strictures are more common after TURP. After TURP, patients are catheterized for an average of 2-4 d, whereas many patients undergoing TUMT have prolonged catheterization because of prostatic edema. There is an increased risk of urinary tract infection after TUMT because of the longer duration of catheterization and the remaining in situ necrotic tissue. Retrograde ejaculation has been reported to occur in48-90% of patients after TURP compared with 0-29% after TUMT (27).

Erectile dysfunction after TURP or TUMT is rare if a patient is previously normal but is commonly observed in patients with prior erectile difficulties. Although the cause has not been fully elucidated, psychogenic factors, bladder neck trauma, and neurogenic voiding dysfunction probably play a role. Lower-energy TUMT protocols have a lower incidence of erectile dysfunction (28) reported an incidence of erectile dysfunction in 18.2% of patients undergoing high-energy TUMT, compared with 26.5% for TURP.

Overall, satisfaction with sex life seems to be higher in patients who have had TUMT than in patients who have had TURP, with 55% of patients undergoing microwave thermotherapy reported as very satisfied vs 21% of those who underwent TURP. However, only 27% of this population were satisfied with their urinary flow after TUMT compared with 74% of patients after TURP.

The risk of acute myocardial infarction in the posttreatment period is not negligible with TUMT. There is a higher risk of myocardial infarction after both TURP and TUMT, especially more than 2 yr after therapy (29). More patients died from cardiovascular disease from both therapies than would be expected in the general population. The explanation for this finding is not understood.

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