Is trans-urethral bipolar radiofrequency (RF) thermotherapy, a minimally invasive treatment for bph, superior in late term results against transurethral prostate resection (TUR-P)?

Introduction: Benign Prostatic Hyperplasia (BPH) is common in ageing men. Maximum urine flow rate (Qmax), post-void residue (PVR), prostate volume (PV) and International Prostate Symptom Score (IPSS) are used in its diagnosis. Depending on the patient, lifestyle changes, medical treatment, minimally invasive treatment or surgical treatment are used in the treatment. Trans-Urethral Prostate Resection (TUR-P), which is the gold standard treatment in the guidelines, carries many risks for patients, such as anesthesia risk, bleeding, infection, urethral stenosis, and urinary incontinence. Due to these risks in patients with advanced age and high comorbidities, Trans-Urethral Radiofrequency Ablation (RF) thermotherapy, which can be performed with local anesthesia, has fewer complications, and is a repeatable method, comes to the fore. The aim of this study is to investigate the effectiveness of RF thermotherapy against TUR-P in the late period. Material and methods: The results of 37 patients who underwent TUR-P and 34 patients who underwent RF Thermotherapy between April-2017 and December-2022 were recorded prospectively and reviewed retrospectively. Qmax, PV, PVR, IPSS, IPSS-QoL of all patients before the procedure and 1 year after the procedure were recorded. In addition, a one-question survey reporting the need for additional treatment, procedure complications, and satisfaction with the procedure was also recorded. Results: The mean age was 68.61±8.6 years in the TUR-P group and 75.09±8.7 years in the RF thermotherapy group. The mean age and cardiovascular disease were statistically significantly higher in the RF thermotherapy group. The number of catheterized patients was statistically significantly higher in the RF thermotherapy group. Although the improvement in PV, PVR and Qmax was not statistically significant, it was higher in the TUR-P group. When the groups were compared in terms of improvement in IPSS and IPSS-QoL, statistically significant improvement was high in the TUR-P group. When the groups were compared, patient satisfaction was statistically significantly higher in the TUR-P group and the need for retreatment was statistically significantly higher in the RF thermotherapy group. No statistically significant difference was observed in terms of complications. Conclusion: Although RF thermotherapy is not recommended as the gold standard in the treatment of BPH, it has been evaluated that it may be an alternative treatment to TUR-P in selected patient groups. The fact that it can be applied under local anaesthesia without the need for general or regional anaesthesia is also advantageous. RF thermotherapy may be offered as a preferable method especially for patients with advanced age, high comorbidities, inability to discontinue blood thinners, and high ASA score because it has a lower risk of complications and does not require anaesthesia.