All patients undergoing transurethral procedures must have a documented sterile urine culture and must be evaluated for prostate or urothelial cancer if it is clinically suspected. The underlying neurogenic problem should be evaluated and treated in patients with neurogenic bladder voiding dysfunction.
Contraindications specific to TUMT are evolving as the technology changes and outcomes are studied further. Patients with a history of TURP or pelvic trauma should not undergo TUMT because of potential alterations in pelvic anatomy. Patients with glands <25 gm or with a prostatic urethral length <2.0 cm respond poorly to TUMT, as do patients with glands >100 gm or patients with a prominent median bar or middle lobe. Other contraindications include the presence of a penile prosthesis, severe urethral stricture disease, Leriche syndrome/severe peripheral vascular disease, or an artificial urinary sphincter. Patients with pacemakers should consult their cardiologist concerning pacemaker management during therapy. Hip replacement is no longer a contraindication. Acute urinary retention was previously thought to be a contraindication to TUMT; however, high-energy TUMT has shown promise in this population, although efficacy has yet to be determined.
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