Pain sensation in transurethral microwave thermotherapy for benign prostatic hyperplasia: the rationale for prophylactic sedation.

Abstract

Transurethral microwave thermotherapy (TUMT) can be painful. Pain sensation limits treatment tolerance and consequently also treatment efficacy. Of our population of patients treated with TUMT, 22% (63/288) needed intravenous analgesia and, nevertheless, 6% (17/288) needed definitive treatment interruption. The aim of this study was to identify the mechanism of pain sensation during TUMT and to verify whether the prophylactic use of a sedative drug would improve treatment tolerance. Eighty-three patients undergoing TUMT treatment for benign prostatic hyperplasia at our department entered a prospective, randomized, single-blinded study. Thirty minutes before treatment, 40 patients (group A) received 960 mg cotrimoxazole orally while 43 patients (group B) received 960 mg cotrimoxazole and 10 mg oxazepam, both orally. Statistically significant improvement in treatment tolerance in group B in comparison with group A was found. Pain sensation during TUMT seemed to be mostly due to anxiety. It is concluded that the prophylactic use of a sedative drug is advisable in patients undergoing TUMT in order to improve treatment tolerance.