The latest “minimally invasive” surgical approach to treatment of urinary symptoms caused by an enlarged prostate is WATER-INDUCED THERMOTHERAPY, abbreviated as WIT. This treatment was first developed in Israel, but now has been subjected to international clinical trials and is becoming available in the United States.WIT is in some ways similar to the microwave thermotherapy technologies which are already widely available for treatment of symptomatic prostatic enlargement due to benign prostatic hyperplasia (BPH).
In both, the treatment energies are delivered to the enlarged prostate through a catheter or tube which is placed in the urethra. Both are relatively simple outpatient procedures.However, WIT uses nothing more complicated than the direct application of heat energy from circulating hot water to heat the prostate and relieve urinary symptoms due to BPH.
At the end of the WIT treatment, a catheter (a small hot water balloon) sits inside the prostate when properly positioned. During WIT treatment, hot water at a temperature of 60 degrees Centigrade (140 degreees Fahrenheit) is continuously circulated through the treatment balloon to heat the prostate.
There appears to be minimal sensation in the part of the prostate being heated, and reported patient discomfort during WIT therapy is minimal or mild. Thus, WIT treatments can be easily performed in the doctor’s office rather than the operating room. The WIT hot water treatment lasts for 45 minutes, after which the treatment catheter is removed and a new drainage tube or catheter is replaced in the bladder to allow proper drainage of urine while the prostate recovers from the treatment and swelling caused by the heating dissipates.
This postoperative drainage catheter is usually required for several days after treatment before spontaneous urination resumes again.After WIT treatment, patients can expect gradual improvement and resolution of their urinary symptoms caused by an enlarged BPH prostate. Ongoing improvement in urination may progress over the course of several weeks after treatment. Final results appear as good or better than many other treatments now available for BPH, including drug therapy and microwave thermotherapy.
WIT also appears quite safe, with very few side effects or complications.The MAJOR disadvantage of WIT treatment is the need for a urinary catheter to drain the bladder for several days after this therapy. In 12 percent of patients, this drainage tube or catheter was needed for more than a month following treatment!Also, not every prostate may be the proper size and shape to be appropriately treated with WIT.
Although the hot water balloons used for WIT are made in a range of sizes, very small and very large prostates may not be accommodated by the available balloon lengths and so cannot be properly fit and treated with this technology (the same problem occurs with available microwave treatment catheters). Prostates which have a large median lobe which extends up into the bladder also cannot be properly treated with WIT or microwave technologies as they currently exist. Finally, WIT is not recommended as a treatment for men with prostate cancer.