A Cochrane review included 15 studies with a total of 1 585 subjects with moderately severe lower urinary tract symptoms. Transurethral microwave thermotherapy (TUMT) was compared with sham thermotherapy procedures (8 studies), with an alpha blocker (1 study), and with transurethral resection of the prostate (TURP, 6 studies). TUMT improved symptom scores (International Prostate Symptom Score, IPSS: WMD -5.15, 95% CI -4.26 to -6.04) and peak urinary flow (WMD 2.01 mL/s, 95% CI 0.85 to 3.16) compared with sham procedures. TUMT also improved IPSS symptom scores (WMD -4.20, 95% CI -3.15 to -5.25) and peak urinary flow (WMD 2.30 mL/s, 95% CI 1.47 to 3.13) in the one comparison with alpha blockers.
The pooled mean urinary symptom scores decreased by 65% with TUMT and by 77% with TURP. The WMD for the IPSS symptom score was -1.00, 95% CI -2.03 to -0.03, favoring TURP. The pooled mean peak urinary flow increased by 70% with TUMT and by 119% with TURP. The WMD for peak urinary flow was 5.08 (95% CI 3.88 to 6.28) mL/s, favoring TURP. Compared to TURP, TUMT was associated with decreased risks for retrograde ejaculation, treatment for strictures, hematuria, blood transfusions, and the transurethral resection syndrome, but increased risks for dysuria, urinary retention, and retreatment for benign prostatic hyperplasia symptoms.