Cooled ThermoTherapy™ (TUMT)

What Does TUMT Stand for?

TranUrethral Microwave Thermotherapy of the prostate.

What Is a TUMT?

TUMT is a minimally-invasive, office-based, outpatient procedure which heats up the prostate tissue using microwave energy to treat the urinary symptoms caused by an enlarged prostate. By heating the prostate, the center of it will shrivel up somewhat like a plum becoming a prune. The result is that the central channel through which the urine runs out from the bladder (i.e., the urethra) opens up resulting in better urine flow and improvement in urinating complaints.

What Is the Prostate?

It is a walnut-sized gland that surrounds the urethra (the tube through which you urinate) where the urethra joins the bladder. As men get older, the prostate can grow inward (& outward) causing a progressive obstruction to the flow of urine out of the bladder.

Why Am I Being Scheduled for a TUMT?

You are having a TUMT most likely because of persistent urinary complaints, and you may have even stopped urinating altogether, requiring a urinary catheter to be placed (known as urinary retention). The outcome of this procedure is similar to a TUMT (microwave procedure of the prostate) but which procedure is done is based on the anatomy of each man’s individual prostate.

How Is the TUMT Performed?

In the office, awake, using local anesthesia. Numbing liquid is placed in the urethra as well as into the bladder. A special microwave treatment catheter is placed through the penis to the bladder and a balloon is inflated inside to prevent it from sliding out during the procedure. Microwave energy is delivered to the prostate tissue from coils on the catheter, thereby heating the gland, which eventually results in the tissue shriveling up circumferentially (like the cake of a doughnut) and thus the central channel (the urethra) opening up which will make urination easier. The procedure takes 30 minutes not including preparation time. At the completion of the operation, a catheter tube is placed through the penis into the bladder to drain the urine. This catheter usually stays in for 3-7 days and is removed by our staff in the office.

What Are the Benefits of the TUMT?

You might receive the following benefits. The doctors cannot guarantee you will receive any of these benefits. Only you can decide if the benefits are worth the risks.

  1. Done under local anesthesia so able to avoid general or spinal anesthesia
  2. Done in the office so able to avoid expensive hospital copays/charges
  3. Relief of urinary obstruction
  4. Improved ability to urinate and empty the bladder
  5. Significantly reduced chance of bleeding from the prostate
  6. Decreased risk of infections
  7. Decreased risk of bladder stone formation
  8. Potential to stop all prostate / urinary related medications
  9. Essentially no chance for hospital stay and significant bleeding as compared to the traditional TURP or GreenLight Laser surgeries.

What Are the Risks Associated with TUMT?

Before undergoing this procedure, understanding the associated risks is essential. No procedure is completely risk-free. The following risks may occur, but there may be unforeseen risks and risks that are not included on this list. Some of these risks, if they occur, may necessitate additional surgery, prolonged hospitalization, and/or extended outpatient therapy to permit adequate treatment.

COMMON

  • Bleeding is the most common complication. Typical bleeding is very mild (cranberry juice). Some people have wine colored or dark urine, which is essentially old bleeding that is resolving. Some people may pass small pieces of blood that are small blood clots. These are not harmful but may sometimes clog up the catheter and make it difficult to drain urine. If you do experience heavy and persistent bleeding that looks like you’re urinating tomato soup and or unable to urinate because of heavy clots, contact the surgeon immediately. You may need additional treatment to stop the bleeding or to remove blood clots. Bleeding can be life-threatening and may necessitate a blood transfusion.
  • Pain that may be related to the catheter. Urgency to urinate due to the catheter. Burning with passage of urine after the catheter is removed. These symptoms usually resolve over the course of a few days. You may find that medications such as Pyridium, Uribel or AZO, and increasing fluid intake for a few days after the procedure, may help.
  • Temporary mild burning, urgency or frequency of urination after the procedure. This is very common and is the result of the edges of the prostate where the surgery was done healing. The duration of these side effects varies and may last from a few days to a few months.
  • You may not ejaculate normally such that less or no semen is produced during orgasm (dry orgasm) in 25-50% patients after the procedure (retrograde ejaculation). This is a fairly common side effect with TUMT (over 80% in men undergoing TURP or Greenlight Laser ablation), and is present because men ejaculate through the prostate. The TUMT may result in opening the urethra channel significantly enough that it may not be able to close completely with ejaculation (as it normally does so) and thus retrograde ejaculation occurs. This is not harmful, however, if you are planning to have any more children, this surgery may make it difficult for you to father children.

OCCASIONAL

  • Urine infection requiring antibiotics. This risk is more common in patients who have a catheter prior to surgery or patients who have a history of recurrent infections. Some patients require antibiotics prior, during and after surgery. If you’re experiencing fevers, chills or other signs of an infection just prior to or on the day of surgery, please make the surgeon aware as operating with an active infection may raise your risk of a serious blood infection and may be lethal.
  • Possible need to re-operate in the future due to recurrent obstruction. Typically, the prostate continues to grow even after the operation. On average, it takes about 7-10 years for the prostate to regrow enough to worsen your urinary symptoms again. That is why it is still important to see the urologist even years after your surgery was completed. In certain cases, we have patients continue with medicines that shrink the prostate to slow down the regrowth of the prostate
  • Failure to pass urine after surgery requiring another catheter and even more invasive surgery (Greenlight Laser or TURP)
  • Difficulty to empty the bladder may happen if the prostate area is still swollen after the recent surgery, some patients need to have a catheter draining their bladder a bit longer until this subsides.
  • There are rare cases where patients develop scar tissue either at the prostate or the tip of their penis making it difficult to urinate. This may require further procedures to fix.
  • The operation may not relieve some of your symptoms. This is seen in about 10% of patients.
  • If patients have a history of chronic enlarged prostate problems, this may result in the bladder being more overactive. Unfortunately, the bladder over activity is not reversible and is not improved with the prostate operation. Thus, patients may have improvement in their flow and may empty their bladder better after surgery, but their urgency, frequency and sometimes urge related leakage may not improve and will require continued bladder medications, or other treatments, for overactive bladder.

RARE

  • Impotence – difficulty getting an erection that occurs in 1% of patients. This has become a very rare complication.
  • Urinary incontinence - Temporary or permanent loss of urinary control. This is typically a result of the damage of a muscle (sphincter) that sits below the prostate. It almost NEVER occurs in TUMT patients. There is a higher likelihood of incontinence with the Greenlight Laser or TURP.
  • Permanent urinary retention - permanent need to use a catheter or the need to self-catheterize after the procedure to fully empty the bladder. This condition is NOT a result of the surgery, but rather a result of chronic urinary retention prior to surgery resulting in a very weak bladder. This problem is typically discovered prior to surgery with bladder function testing like Pressure Flow or Urodynamics. Some patients are given a chance to see if their bladder function improves with the opening of the prostate with this operation, but the bladder never fully recovers and the bladder muscle does not work well, thus resulting in urinary retention. The medical term for this is an “atonic or neurogenic” bladder. Some patients are still good candidates for this surgery even if their bladder does not work, just to open up the prostate with the Greenlight so as to make catheterization easier on the patient in the future.
  • Injury to urethra causing delayed scar formation, which can obstruct urethra.
  • Very rarely perforation of the bladder (hole in the bladder) requiring temporary insertion of a catheter or open surgical repair.
  • Injury to the ureteral openings (opening of the kidney tubes that drain into the bladder) requiring temporary stenting (plastic tube in the kidney) or ureteral repair

Risks Associated with ANY Surgery:

  1. Anesthesia-related complications
  2. Blood clots in the veins (in the legs or lungs). These can be life-threatening and usually require treatment with a prolonged course of blood thinners.
  3. Heart attack
  4. Stroke
  5. Pneumonia
  6. Allergic reaction to drugs and/or equipment
  7. Electrolyte (salt) imbalances

Alternatives to a TUMT Procedure

  • No treatments at all (aka observation) - Observation is a great option for patients with mild symptoms. If you are considering surgery, likely your symptoms are getting bad enough where you are seeking more drastic help. We are not inclined to force any patients to undergo any procedures that they are unwilling to do. Certainly, patients may elect to undergo absolutely no intervention. We do, however, want all patients to be aware of the possible risks of delaying intervention and the possible outcomes of letting the enlarged prostate problems get out of hand. Please click here to learn more.
  • Medications – usually not as effective as surgery, can have side effects, and you will need to take it for the rest of your life.
  • Microwave of the Prostate - this is an office procedure that involves placing a small catheter tube into the penis that contains a microwave antenna and heats the prostate over a short period. The heating of the prostate will eventually make the prostate smaller and improve urinary symptoms
  • Rezuum - an office procedure under a local anesthetic, where via a camera placed into the penis and prostate, steam is injected into the prostate and heats the prostate, which eventually makes the prostate shrink.
  • Transurethral Prostatectomy (TURP) is the standard operation for prostate enlargement. Laser Prostatectomy has similar effectiveness to TURP in published studies. TURP has a higher risk of bleeding compared to laser prostatectomy so you may need to stay in hospital a day or two longer with a catheter.
  • Transurethral Incision of Prostate (TUIP) - also sometimes called Bladder Neck Incision. May be recommended for small prostates that are a bit too narrow.
  • UroLift – either done in the surgery center or office, the procedure is done by placing a small rigid camera in the penis and prostate and deploying clips on either side of the prostate so as to compress the obstructing parts of the prostate and open up the urinary channel
  • Open or Robotic Suprapubic Prostatectomy – recommended in extremely large glands, that are too big to manage with minimally invasive surgery. This is not a common treatment. It involves either through open or robotic/laparoscopic methods, removing the prostate via an incision in the belly and bladder and coring out the inner part of the prostate. This is not the same operation that we do for prostate cancer, but is similar in the approach.
  • Long-term catheter – recommended if you are not fit for any operation and unable to urinate at all or retaining very large volumes of urine in the bladder. May be a catheter through the penis or a tube that is placed below the belly button to drain the bladder.

Getting Ready for Your Operation

You MAY be required to visit your primary care doctor for “clearance” for the operation. Typically, this is a general checkup that includes checking your heart, lungs, bloodwork, EKG, chest x-ray and any other necessary tests to ensure that you are fit and ready for surgery. Your primary doctor will notify you if you need to see any other specialists such as a cardiologist or pulmonologist to make sure that you are ready for the operation.

Tell the doctor if you:

  • take medication to thin your blood (anticoagulants), such as: Aspirin, clopidogrel, plavix, dalteparin, fragmin, rivaroxaban, xarelto, heparin, lovenox, warfarin, coumadin, prasugrel, effient
  • take steroids such as prednisone or arthritis medications
  • take any other medications, such as herbs, vitamins, minerals, or natural or home remedies.
  • have taken any antibiotics in the past 3 months.
  • have any type of heart condition, implanted devices such as knee or hip replacements.
  • are allergic to any medications or latex.
  • had a urinary tract infection (UTI) in the last month.
  • had an infection or were hospitalized after a previous prostate biopsy.
  • have a history of Achilles tendon injuries or tendonitis.
  • work at a hospital or nursing home.

5 to 7 Days Before Your Procedure

Stop taking:

  • aspirin and medications that contain aspirin, unless directed otherwise by the doctor
  • vitamin e, multivitamins
  • Stop taking other stronger blood thinners (like plavix, xarelto or warfarin) as directed by your primary doctor or cardiologist

2 Days Before Your Procedure

  • Stop taking pain medicines like: ibuprofen (advil® or motrin®) or naproxen (aleve®)

What should I expect after the procedure?

After your operation, once the catheter is placed, we will observe you for 10-20 minutes and then you may return to your home with someone else driving you home. A drainage bag attached to the catheter, and strapped to your leg, will collect urine.

You MUST arrange for a ride home.

Post-Op Discharge Information

Catheter

A urinary catheter is a tube that runs from the bladder out through the tip of the penis and drains into a bag. It is important to drain the urine in this way until the urine is clear. Your catheter is usually removed 5-7 days after your operation. Avoid pulling on the catheter as this may provoke bleeding. It is common for urine to occasionally squirt around he catheter at the tip of the penis. It is also very common to have a bit of blood dripping around the catheter at the tip of the penis.

We advise putting a small amount of antibiotic ointment such as Neosporin or Bacitracin at the tip of the penis several times per day to allow the catheter to glide smoothly.

Seek help if all the urine is coming around the catheter and none is draining into the urinary drainage bag. You and your family/friends will be given instructions on the catheter care.

Bleeding

It is quite normal to see an occasional show of blood in your urine during the first month after surgery – this is due to the healing of the operation site. If you see blood, simply increase your fluid intake. If you have prolonged heavy bleeding (>24 hours), significant pain or increasing difficulty passing water, please contact the Broward Urology Center.

Pain

Because there are no external cuts, this procedure is relatively pain free. You may experience some discomfort from the catheter, but this is usually easily treated with mild painkillers. Tylenol may be used for pain. However, we will provide you with a prescription for a stronger pain killer should you need one. Beware, stronger pain killers may cause constipation

Diet

It is important that you do not get constipated. There are no dietary restrictions but you should try and eat plenty high fiber food or anything that would get your bowels moving. You may use milk of magnesia or an enema if you get severely constipated. You will be provided with a stool softener as one of the prescriptions after surgery to prevent constipation. Drink at least 64 oz. of fluids daily including water, drinks with electrolytes, and even soup to increase hydration and reduce bleeding.

Showers

There are no restrictions on taking showers even with the catheter in the penis. Staying and keeping yourself clean is always important. Please do not take baths, go into the pool or ocean with the catheter in place.

Exercise

You should take it easy for a month, although it is important to take some gentle exercise like walking, to reduce the risk of developing a blood clot in your legs. Try to avoid any activity that makes you strain as this will increase your chances of bleeding from the prostate.

You can resume normal sexual activity 2 weeks after your operation.

Work

Recovery may take several weeks. However, most patients feel a lot better as soon as the catheter is removed. We will be able to advise you when it will be safe to return to work as this depends on your occupation. Most patients with a sedentary office job require about a week of recovery, but those who do a lot of straining and lifting, may need several weeks before they are clear to go back to work. We can provide you with an excuse from work an any other paperwork for your job at our offices.

Driving

You may resume driving a motor vehicle you feel well and do not have significant pain or discomfort. You are absolutely not allowed to drive or operate any other motorized device while on narcotic pain killers.

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