sense of urinary urgency. However, only 5% of patients reported their pain as being severe during Targis therapy. Despite this, more than one half of these patients required substantial oral analgesics during treatment. Higher energy protocols appear to have a slightly higher level of initial pain due to the initial higher power, which appears to resolve and return to the same level of comfort as the lower-energy protocols soon into treatment.
Reports of complications vary, and range from 0 to 38%, based on the study and the investigators' criteria for complications. For example, Ohigashi et al. reported no serious side-effects in 91 patients treated with low-power over 5-year followup (25). Others report complications including acute urinary incontinence, urinary tract infection, and urinary retention. The risk for urinary tract infections rises with each day of catheterization. In addition, the necrotic tissue that remains in the prostatic fossa after TUMT may increase the risk of colonization and infection. Treatment morbidity of higher energy protocols is moderate and consists mainly of the need for catheterization and a higher percentage of retrograde ejaculation (17).
Erectile dysfunction after TUMT is rare if a patient is previously normal, but is commonly observed in patients with prior erectile difficulties. Although causes have not been fully elucidated, psychogenic factors, bladder neck trauma, and neurogenic voiding dysfunction probably play a role. Lower-energy TUMT protocols have a lower incidence of erectile dysfunction compared to higher-energy protocols but at the expense of better urinary results. Francisca et al. (43) reported no change in sexual performance after low-energy TUMT when compared to a sham procedure in 147 patients.
A variety of other rare but reported complications following TUMT occur. This includes, but is not limited to, urethrorectal fistula (44), bladder perforation, and improper catheter placement. An emphysematous prostatic abscess (45) has been reported after low-energy TUMT in a 55-year old man with diabetes mellitus and cirrhosis. Proper intratreatment physician and nursing observation are vital to decrease these risks.
