Using water vapor thermal therapy to treat lower urinary tract symptoms (LUTS) caused by an enlarged prostate could have fewer sexual side effects than medications, a new study suggests.
The therapy is administered only once, while medications are taken over the long term, the authors pointed out.
For many men, the prostate gland grows larger with age. Because tissue grows inward, it can squeeze the urethra, which runs through the gland. As a result, men may have trouble with urination, often referred to as LUTS.
Depending on the situation, an enlarged prostate may be treated with medication, minimally invasive procedures, or surgery. In recent years, water vapor thermal therapy has been investigated. This approach uses doses of water vapor, administered by a device threaded up the urethra, to destroy excess prostate tissue. It may be performed at a doctor’s office, surgery center, or hospital.
The findings of the current study are based on a comparison of two earlier studies of men with benign prostatic hyperplasia (BPH – the medical term for an enlarged prostate). Some of the men took medications, the others underwent water vapor thermal therapy.
First, the Medical Therapy of Prostatic Symptoms (MTOPS) study involved 3,047 men with BPH aged 50 and older who were randomly assigned to one of four groups, receiving a placebo, doxazosin (an α-blocker), finasteride (a 5α-reductase inhibitor), a combination of doxazosin and finasteride. Medications were taken daily. In addition to treatment efficacy, the participants’ sexual function was assessed at baseline and annually using the Brief Male Sexual Function Inventory (BMSFI).
Second, the water vapor thermal therapy study included 197 men with BPH, also aged 50 and older. They were randomly assigned at a 2:1 ratio to receive a single treatment of either water vapor therapy or a sham therapy (a similar procedure, with no water vapor involved). In this group, the International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire were used to evaluate sexual function.
The researchers identified sexually active men from each study (1,209 from MTOPS and 86 from the water vapor therapy study) who had similar LUTS severity and prostate size. Using the sexual health data, they compared the groups’ baseline and annual assessments for three years.
They found that when compared to the men who underwent water vapor therapy, the men who took finasteride and the combination drug therapy had lower sexual desire, and poorer erectile and ejaculatory function. Men who took doxazosin had lower desire and more problems with erections.
In contrast, the men in the water vapor therapy group had no significant worsening in sexual function over the three-year period.
Drug combination therapy and water vapor therapy appeared to improve LUTS symptoms, and water vapor therapy worked better than finasteride and doxazosin alone.
The authors noted that the over half of men taking BPH medications discontinue them after twelve months because of side effects or lack of symptom improvement. Medication may also be costly, while water vapor thermal therapy could be cost-effective.
“Clinicians should consider this therapeutic option to improve LUTS while preserving libido, erectile, and ejaculatory function in men,” they commented.
The use of different sexual health assessments and the lack of data on confounding factors were noted as limitations. In addition, the findings might not be generalizable to other BPH drugs.
Experts caution that there are no long term data about safety and recurrence of symptoms after water vapor thermal therapy. There is also no data on its use after radiation therapy.
In addition, experts note that water vapor thermal therapy should not be conducted within 30 days of a prostate biopsy or surgery. It is not recommended for patients with a urinary sphincter implant or penile implants.
The study was published online in November 2018 in the Journal of Sexual Medicine.
International Society for Sexual Medicine
“What is water vapor thermal therapy and what is it used for?”
The Journal of Sexual Medicine
McVary, Kevin T., MD, et al.
“Is Sexual Function Better Preserved After Water Vapor Thermal Therapy or Medical Therapy for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia?”
(Full-text. First published online: November 13, 2018)