What should I know about using cooled thermotherapy for an enlarged prostate?
Quick Answer
Cooled ThermoTherapy is an older minimally invasive treatment for benign prostatic hyperplasia (BPH) based on transurethral microwave thermotherapy (TUMT). It is not a laser procedure.
A catheter placed through the urethra delivers microwave energy that heats selected prostate tissue, while a cooling system protects the urethral surface. The treated tissue is damaged by heat and gradually shrinks, which can reduce obstruction and improve urinary symptoms.
Although TUMT was FDA approved and can improve BPH symptoms, it is now generally regarded as a legacy technology. Current practice more often uses medications or newer procedures such as water-vapor therapy, prostatic urethral lift, HoLEP, TURP and other techniques, depending on prostate anatomy and patient priorities.
Hello James,
Cooled thermotherapy was developed as a way to treat benign prostatic hyperplasia (BPH) without making a surgical incision. However, several details in the original explanation of this treatment were incorrect and need to be clarified.
What Is Cooled ThermoTherapy?
The term usually refers to a form of transurethral microwave thermotherapy (TUMT). One well-known system was the Prolieve Thermodilatation System.
The FDA approved Prolieve as a minimally invasive, non-surgical treatment for symptomatic BPH in selected men. Its original indication included men with prostates weighing approximately 20 to 80 grams and a specified prostatic urethral length.
How Does It Actually Work?
Cooled thermotherapy does not use a laser.
A specially designed catheter is passed through the urethra and positioned in the prostatic urethra. The catheter delivers microwave energy to heat prostate tissue surrounding the urethra.
At the same time, the device circulates cooling fluid to help protect the urethral lining while the deeper prostate tissue is heated.
The heat damages selected prostate tissue. Over time, the treated tissue contracts or is reabsorbed, which can create more space around the urethra and improve urine flow.
Is It the Same as Rezūm Water-Vapor Therapy?
No. These are different technologies.
| Feature | Cooled Thermotherapy / TUMT | Water-Vapor Thermal Therapy |
|---|---|---|
| Energy source | Microwave energy | Steam / water vapor |
| How tissue is treated | Microwave heating causes thermal injury to obstructing prostate tissue | Small injections of steam transfer thermal energy into targeted tissue |
| Current role | Older or legacy technology | Still included as a contemporary minimally invasive BPH option in AUA guidance for appropriately selected men |
| Goal | Reduce obstruction and improve urinary symptoms | Reduce obstruction and improve urinary symptoms |
Is Cooled Thermotherapy Still Used?
It may still be available in some settings, but it is much less prominent than it was when the original article was written.
An important update is that the 2023 AUA BPH guideline amendment removed the previous recommendation statements for TUMT and moved discussion of TUMT into the background section as a legacy technology.
This does not mean the procedure never worked. Earlier evidence showed that TUMT could improve urinary symptoms in selected patients. Rather, the BPH treatment landscape has changed and newer technologies now have a larger role in contemporary practice.
How Effective Is TUMT?
TUMT can improve lower urinary tract symptoms and urine flow in some men with BPH. However, symptom improvement is generally not as immediate as with tissue-removing procedures, because the thermally treated tissue needs time to shrink.
Historically, one of the trade-offs was that minimally invasive microwave treatment could have a lower perioperative burden than conventional surgery, but patients could have a greater likelihood of needing additional treatment later compared with more definitive tissue-removing procedures.
That possibility is important when comparing it with BPH surgery and modern procedures.
Who Might Have Been Considered for Cooled Thermotherapy?
The FDA’s original Prolieve indication covered selected men with symptomatic BPH and specific prostate-size and urethral-length criteria.
Before any BPH procedure today, a urologist would normally consider:
- how severe and bothersome your symptoms are;
- prostate size and shape;
- whether there is a significant median lobe;
- post-void residual urine;
- urine-flow measurements;
- previous urinary retention;
- bladder stones or recurrent infections;
- medications you have already tried;
- your priorities regarding ejaculation and sexual function; and
- which procedures are available and performed regularly by the treating urologist.
See our guide to tests used when evaluating an enlarged prostate.
Who Should Not Receive This Treatment?
The original FDA labeling for Prolieve listed several contraindications, including:
- current urinary or prostate infection;
- severe urethral stricture preventing catheter placement;
- certain penile or urinary sphincter implants;
- prostate size outside the device’s approved range; and
- certain conditions in which the patient’s ability to perceive treatment-related pain is substantially impaired.
Eligibility must therefore be determined by the treating urologist and by the specific device being used.
What About Prostatitis?
Cooled thermotherapy should not be described as failing simply because it “cannot kill all the bacteria.” That explanation is too simplistic.
Bacterial prostatitis is an infection requiring appropriate diagnostic evaluation and antibiotic treatment when indicated. A BPH thermotherapy procedure is not an infection treatment, and an active urinary or prostatic infection was a contraindication in the original Prolieve labeling.
What About Prostate Cancer?
Cooled thermotherapy is not a treatment for prostate cancer because it was developed to reduce urinary obstruction caused by benign prostate enlargement.
However, the old claim that every patient with prostate cancer requires removal of the entire prostate is incorrect.
Depending on stage, risk group, age and overall health, prostate-cancer management may include:
- active surveillance;
- radical prostatectomy;
- radiation therapy;
- hormonal therapy;
- systemic drug treatment; or
- combinations of these approaches.
You can read more in our guide to prostate cancer treatment options.
What Side Effects Can Occur?
Possible short-term effects of transurethral microwave thermotherapy can include:
- urinary urgency or frequency;
- burning or discomfort during urination;
- blood in the urine;
- temporary difficulty urinating;
- need for temporary catheterization;
- urinary tract infection; and
- pelvic or urethral discomfort.
Recovery and symptom improvement vary between patients, and urinary symptoms may initially worsen before improving as swelling settles and treated tissue changes over time.
How Does It Compare With Modern BPH Options?
Today, men considering an intervention have a broader range of options than when cooled thermotherapy was introduced.
| Approach | General role |
|---|---|
| BPH medications | Often the first treatment when symptoms justify therapy; includes alpha blockers and 5-alpha-reductase inhibitors in selected patients. |
| Water-vapor thermal therapy | Minimally invasive option for appropriately selected prostate anatomy and size. |
| Prostatic urethral lift | Mechanical opening of the prostatic urethra in selected patients; often discussed when preserving ejaculation is important. |
| TURP | Established tissue-removing operation with strong symptom and flow improvement. |
| HoLEP / laser enucleation | Highly effective tissue-removing treatment that can be used across a wide range of prostate sizes in experienced hands. |
| Cooled thermotherapy / TUMT | Older minimally invasive microwave technology that now has a much smaller role in contemporary BPH practice. |
Should You Choose Cooled Thermotherapy Today?
I would not choose the procedure simply because it is described as “non-surgical” or because it avoids an incision.
Instead, ask your urologist:
- Is this actually TUMT, and which device will be used?
- How often does your center still perform this procedure?
- Why is it preferable for my prostate anatomy compared with newer options?
- What symptom improvement should I realistically expect?
- How often do patients need another BPH procedure later?
- Will I need a catheter afterward?
- What are the alternatives for my prostate size?
- How will each option affect ejaculation, erections and continence?
Cooled thermotherapy was a legitimate minimally invasive BPH technology, but the original explanation on this page overstated its effectiveness and incorrectly described it as a laser-based procedure.
Today I would consider it an older option rather than a first-choice modern procedure. If it is being offered to you, ask the urologist why TUMT is preferable in your particular case compared with current alternatives such as medication, water-vapor therapy, prostatic urethral lift, TURP or HoLEP.
The best procedure depends on your prostate size and anatomy, urinary symptoms, residual urine, previous treatments, health status and your priorities regarding recovery and sexual function.
Dr. Albana Greca, MD, MMedSc
Family Physician / General Practitioner
Founder & Lead Medical Author, Prostate Treatment Options
Medical References
U.S. Food and Drug Administration. Prolieve Thermodilatation System, PMA P030006: indication, device description and contraindications.
American Urological Association. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: Guideline Amendment 2023.
European Association of Urology. Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms.
Last evidence update: September 2026.