Water-induced thermotherapy of the prostate is a minimally invasive procedure to cure BPH<\/a>.\u00a0<\/p>\n\n\n\n It achieves a thermal lesion in the prostate gland through the application of hot water.\u00a0<\/p>\n\n\n\n The rapid flow of heated water causes coagulative necrosis of the prostate, leading to ablation of the gland.<\/p>\n\n\n\n In other words, it kills target cells and clears the way from the obstructing prostate tissue.<\/p>\n\n\n\n This procedure uses a disposable catheter connected to a console that heats the water.\u00a0<\/p>\n\n\n\n The technician can also control the treatment status, timing, and other parameters from the console.\u00a0<\/p>\n\n\n\n The catheter also connects to a balloon near the tip.\u00a0<\/p>\n\n\n\n It inflates to keep the catheter in place. This balloon is not filled with heated water and will not damage the urethra or the bladder neck.\u00a0<\/p>\n\n\n\n A second balloon is located in the prostatic urethra. This is where the heated water goes (1,2).<\/p>\n\n\n\n The procedure starts by administering topical anesthesia to your urethra. The doctor will then insert the catheter.\u00a0<\/p>\n\n\n\n Once positioned into the bladder, the catheter will be anchored by inflating the balloon.\u00a0<\/p>\n\n\n\n After that, the doctor turns on the console, and the hot water starts to flow in the prostatic urethra.\u00a0<\/p>\n\n\n\n The temperature of the water reaches 60\u00baC. The procedure only lasts 45 minutes, counting the warming up and cooling down of water.<\/p>\n\n\n\n When the balloon expands in the initial phase of the procedure, it compresses the target tissue. Such compression of the prostate reduces the blood flow to the gland temporarily.\u00a0<\/p>\n\n\n\n By doing so, the heat does not dissipate, and the surface area in contact with heat increases.\u00a0<\/p>\n\n\n\n Meanwhile, the bladder neck is protected by the inflated balloon, which does not have a heated source (1).<\/p>\n\n\n\n Studies published so far have evaluated the tolerance of the procedure and what happens in the prostate gland.<\/p>\n\n\n\n After hot water thermoablation, the prostate reaches a temperature of up to 43\u00baC.\u00a0<\/p>\n\n\n\n Local anesthetics are usually enough, and most patients do not feel discomfort with this temperature.\u00a0<\/p>\n\n\n\n All patients, even those who reported discomfort during treatment, had the same extent of necrosis.<\/p>\n\n\n\n What this treatment does is burn part of the prostate and kill cells using a high temperature.\u00a0<\/p>\n\n\n\n These cells are then cleared from the prostatic urethra, and the symptoms of benign prostatic hyperplasia improve.\u00a0<\/p>\n\n\n\n It does not solve prostate enlargement but reduces the effect of an enlarged prostate<\/a> in the urinary tract (3).<\/p>\n\n\n\n This effect is not immediate.\u00a0<\/p>\n\n\n\n The necrotic tissue will stay in place for some time. It will be slowly absorbed from the urethra.\u00a0<\/p>\n\n\n\n When it does, the mechanical obstruction caused by this excess prostate tissue will clear out.\u00a0<\/p>\n\n\n\n Other studies also suggest that heated water changes the disposition of adrenaline receptors in the muscle fibers.\u00a0<\/p>\n\n\n\n Thus, it has a similar effect to that of tamsulosin and other alpha-blockers.\u00a0<\/p>\n\n\n\n Neuromodulation (nerve tissue changes) in response to heat may also reduce irritative symptoms (4).<\/p>\n\n\n\n Followed-up patients report improvements in their lower urinary tract symptoms.\u00a0<\/p>\n\n\n\n However, these improvements might be only temporary.\u00a0<\/p>\n\n\n\n After two years, lower urinary tract symptoms are likely to return.\u00a0<\/p>\n\n\n\n Still, almost 90% of patients are satisfied with the procedure and report no discomfort or side effects.\u00a0<\/p>\n\n\n\n Their prostate volume did not go back to normal but reduced by around 3 ccs (2).<\/p>\n\n\n\n You may find this method interesting, but that doesn\u2019t necessarily make you a good candidate.\u00a0<\/p>\n\n\n\n Water-induced thermoablation is recommended for a particular type of patient.<\/p>\n\n\n\n The ideal candidate would meet most if not all of the following requirements (4):<\/p>\n\n\n\n This procedure has not been widely tested in patients with prostatitis<\/a>, prostate cancer, and pelvic pain syndrome. These patients are not ideal candidates.\u00a0<\/p>\n\n\n\n There is not a guideline to use WIT, but most doctors agree that it also has relative contraindications:<\/p>\n\n\n\n Before the procedure, your doctor will run a few tests and evaluations to make sure you\u2019re a candidate.\u00a0<\/p>\n\n\n\n You will need to go through something called cystoscopy.\u00a0<\/p>\n\n\n\n This diagnostic test determines the measurement of the prostatic urethra and other parameters.\u00a0<\/p>\n\n\n\n Depending on this measure, your doctor will choose the appropriate balloon length (1,2).<\/p>\n\n\n\n Another critical step to prepare for WIT is administering prophylactic antibiotics.\u00a0<\/p>\n\n\n\n They will be required before and after the procedure to prevent infections.\u00a0<\/p>\n\n\n\n You need to follow instructions to the letter if you want to avoid complications.<\/p>\n\n\n\n This is not the most common procedure to treat BPH, and the literature is scarce.\u00a0<\/p>\n\n\n\n However, most patients have had excellent results.\u00a0<\/p>\n\n\n\n Water induced thermoablation offers these benefits (1,4):<\/p>\n\n\n\n After treatment, your doctor will leave in place a catheter for a variable time.\u00a0<\/p>\n\n\n\n It is usually one week, but some patients may need it for a longer time.\u00a0<\/p>\n\n\n\n Keeping the catheter in place for a longer time increases the risk of side effects.<\/p>\n\n\n\n In a 2-year follow-up study, patients reported a few adverse events (2):<\/p>\n\n\n\n There is no risk of erectile dysfunction, and patients did not experience a reduction of sexual interest.\u00a0<\/p>\n\n\n\n Thus, it is also a prostate treatment that keeps the sexual function intact.<\/p>\n\n\n\n Besides the side effects listed above, there is something else to consider before adopting this technique (1):<\/p>\n\n\n\n For all of the above, water-induced thermotherapy is not a common BPH treatment.\u00a0<\/p>\n\n\n\n Doctors only consider it in very specific cases, as laid out above.\u00a0<\/p>\n\n\n\n There are also concerns about the long-term.\u00a0<\/p>\n\n\n\n Researchers have described the possibility of causing heat injuries in the gland and the urethra.\u00a0<\/p>\n\n\n\n Such injuries could lead to tissue sloughing and recurrent urinary tract infections (4).<\/p>\n\n\n\n Water-induced thermotherapy stands as a promising alternative to other BPH treatment options.\u00a0<\/p>\n\n\n\n For instance:<\/p>\n\n\n\n This is the mainstream BPH treatment.\u00a0<\/p>\n\n\n\n It usually has outstanding results in patients with mild or moderate enlargement.\u00a0<\/p>\n\n\n\n We can administer medical treatment with BPH medication such as tamsulosin or finasteride.\u00a0<\/p>\n\n\n\n However, some patients experience side effects of these drugs and prefer to look for other options.\u00a0<\/p>\n\n\n\n When medical treatment fails, WIT can be an excellent alternative.<\/p>\n\n\n\n This is the most common BPH surgery in cases of moderate and severe enlargement of the prostate.\u00a0<\/p>\n\n\n\n However, it has a higher rate of side effects such as incontinence, blood loss, erectile dysfunction, retrograde ejaculation, etc.\u00a0<\/p>\n\n\n\n Compared with WIT, this technique is much more effective but also has more side effects.<\/p>\n\n\n\n Thermal ablation of the prostate can be achieved with laser therapy, radiofrequency, and other methods.\u00a0<\/p>\n\n\n\n These techniques are more expensive and more commonly used in prostate cancer.<\/p>\n\n\n\n It is a procedure to reduce BPH symptoms<\/a> and prostate size.\u00a0<\/p>\n\n\n\n Similar to WIT, it triggers necrosis of the enlarged prostate tissue. It is also a minimally invasive procedure.\u00a0<\/p>\n\n\n\n However, it consists of blocking the blood flow to certain parts of the prostate instead of applying heat.\u00a0<\/p>\n\n\n\n This procedure might not be appropriate for all patients, especially if they have atherosclerosis in the prostate arteries.<\/p>\n\n\n\n This is a more complex procedure that requires general anesthesia.\u00a0<\/p>\n\n\n\n It is an excellent option because it allows taking a sample of the prostate.\u00a0<\/p>\n\n\n\n It offers the possibility of removing a more considerable amount of tissue.\u00a0<\/p>\n\n\n\n However, the rate of complications and recovery is more challenging to deal with.<\/p>\n\n\n\n Water-induced thermotherapy is a BPH treatment technique without invasive surgery.\u00a0<\/p>\n\n\n\n Unlike surgical treatment, it doesn\u2019t require general anesthesia, and no transurethral incision is made.<\/p>\n\n\n\n It consists of filling the prostatic urethra with a catheter filled with hot water.\u00a0<\/p>\n\n\n\n The heat would cause necrosis of the tissue, which reabsorbs and causes symptom relief, reducing the volume of the enlarged prostate gland.<\/p>\n\n\n\nHow does it work?<\/strong><\/h2>\n\n\n\n
Can it treat BPH?<\/strong><\/h2>\n\n\n\n
Who is a good candidate?<\/strong><\/h2>\n\n\n\n
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Contraindications<\/h3>\n\n\n\n
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How to prepare for water-induced thermotherapy<\/strong><\/h2>\n\n\n\n
Benefits<\/strong><\/h2>\n\n\n\n
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Side effects<\/strong><\/h2>\n\n\n\n
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Risks<\/strong><\/h2>\n\n\n\n
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Water-induced thermotherapy vs. other BPH treatment options<\/strong><\/h2>\n\n\n\n
Medical treatment<\/strong><\/h3>\n\n\n\n
Transurethral resection of the prostate<\/strong> (TURP)<\/h3>\n\n\n\n
Other minimally invasive techniques<\/strong><\/h3>\n\n\n\n
Prostate artery embolization<\/strong><\/h3>\n\n\n\n
Holmium laser enucleation<\/strong><\/h3>\n\n\n\n
Conclusion<\/strong><\/h2>\n\n\n\n
Explore More<\/h3>\n\n\n\n
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