Safety and efficacy of transurethral needle ablation of the prostate for symptomatic outlet obstruction (original) (raw)
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Transurethral needle ablation (TUNA) of the prostate: a clinical and urodynamic evaluation
Urology, 1997
Objectives. This prospective study evaluated the clinical and urodynamic changes in patients with obstruction due to benign prostatic hyperplasia (BPH) treated with transurethral needle ablation (TUNA). Methods. One hundred twenty patients with obstructive uropathy due to BPH were treated with the TUNA procedure between January 1994 and December 1995. All patients were selected according to the criteria established by the guidelines proposed by the International Consensus Committee (World Health Organization, Paris, 1993). The TUNA procedure was performed in an outpatient setting using topical intraurethral anesthesia (2% lidocaine gel). Results. Patients showed a decrease in irritative symptoms as measured by the International Prostate Symptom Score (IPSS) and postprocedure urodynamic parameters. The mean (_+ SD) pretreatment IPSS was 20.8 _+ 4.5. At 3 months, the IPSS decreased to 9.7 _+ 3.0 (108 patients) (P <0.001). At 6 months it decreased to 6.8 + 3.1 (86 patients) and remained at 6.2 ___ 2.9 (72 patients) and 6.7 _+ 3.8 (42 patients) at 12 and 18 months, respectively (P <0.001). At 1 year after treatment, the peak flow rate (Omax) increased from 8.2 _+ 3.4 mLJs to 15.9 _+ 2.1 mL/s and was 14.1 _+ 2.5 mLJs at 18 months of follow-up (P <0.01). Urodynamic re-evaluation performed in 72 patients 12 months after TUNA demonstrated the absence of obstruction in 30 (41.7%). An additional 30 patients (41.7%) had equivocal results, whereas the remaining 12 (16.6%) still had obstruction, according to the Abrams-Griffith nomogram. Mean detrusor pressure at Qmax decreased from 85.3 _+ 18.5 cm H20 to 63.7 _+ 24.9 cm H20 at 12 months of follow-up. Conclusions. Our results confirm that the TUNA procedure is safe and effective when performed as an outpatient procedure. In addition, TUNA produced better results in patients presenting with moderate to severe irritative symptoms and minimal obstruction as determined by pressure/flow studies. UROLOGY 49: 847-850, 1997.
European Urology, 2003
Objective: TUNA has been demonstrated to be a safe and effective therapy for BPH. However the major criticism, as with all alternative treatments for BPH, was the lack of long-term data. We present the clinical outcome of patients treated by TUNA and followed for 5 years. Methods: 188 consecutive patients with symptomatic BPH treated with TUNA were followed for five years in three different centers. All patients were treated using the TUNA II or TUNA III catheters under local anesthesia only without general or spinal anesthesia. Baseline and 5-year follow-up evaluation included urinary peak flow, International Prostate Symptom Score (IPSS) and post-void residual urine (PVR). The number of patients requiring additional medical or surgical treatment was recorded. Statistics were performed using the t-test. Results: At a mean follow-up of 63 months, mean urinary peak flow rate increased from 8.6 ml/s to 12.1 ml/s ( p < 0:01, t-test), IPSS and PVR decreased from 20.9 and 179 ml to 8.7 and 122 ml, respectively (both p < 0:001, t-test). The percentage of patients who improved by at least 50% their peak uroflow and IPSS was 24% and 78% respectively. Mean prostate volume and PSA levels did not change significantly (53.9 cc vs. 53.8 cc and 3.3 vs. 3.6 ng/ml, respectively at 5 years, both p values > 0.05, t-test). Two patients died of unrelated comorbidities and 10 were lost for follow-up. Medical treatment was given to 12 patients (6.4%), a second TUNA performed in 7 patients (3.7%) and surgery indicated in 22/186 (11.1%). Overall 41/176 patients (188 at start, 2 deaths and 10 lost to follow-up) or 23.3% required additional treatment at 5 years follow-up following the original TUNA procedure. Conclusions: TUNA is effective and provides good long-term clinical improvement at 5-year follow-up. TUNA treatment stands the test of time at 5-year follow-up with low and acceptable failure rates. More than 75% of the patients do not need additional treatment for BPH on the long run. #
Urology, 1998
Objectives. To report the safety and efficacy of the transurethral needle ablation (TUNA) procedure for the treatment of clinical benign prostatic hyperplasia (BPH). Methods. One hundred thirty patients with BPH were enrolled in two identical protocols and treated by the TUNA procedure. Entry criteria included an American Urological Association symptom index (AUA SI) of 13 points or higher and a peak flow rate of 12 mL/s or less. Patients were followed up for 12 months. Efficacy parameters included the AUA SI, AUA problem index, BPH impact index (BPH II), quality of life (QOL) score, and peak flow rate. At each visit, side effects were elicited. Follow-up data are available for 93 patients at 12 months. All patients were given intraurethral lidocaine augmented by oral and/or parenteral sedation. No patient received spinal or general anesthesia. Results. All patients tolerated the procedure well, and there were no deaths. Forty-one percent of patients (n = 53) had a catheter placed immediately after the procedure. At 12 months, the AUA SI had decreased from 23.7 to 11.9 (P <O.OOOl ) and the BPH II from 7.5 to 2.5 (P <O.OOO 1 ), whereas the peak flow rate had increased from 8.7 to 14.6 mL/s (P <O.OOOl). Irritative voiding symptoms were noted in 20 patients (16%) at some point during follow-up. Two patients reported erectile dysfunction, and 1 reported retrograde ejaculation. Conclusions. In this prospective study of 130 patients with clinical BPH and lower urinary tract symptoms, TUNA provided substantive and lasting improvement according to AUA SI, BPH II, and QOL scores as well as peak flow rate over 1 year. The TUNA procedure was well tolerated, with few major side effects and complications noted. Longer follow-up is needed to document the maintenance of clinical benefit beyond 12 months.
Noninvasive Urodynamic Evaluation
International Neurourology Journal, 2012
The longevity of the world' s population is increasing, and among male patients, complaints of lower urinary tract symptoms (LUTS) are growing. Testing to diagnose LUTS and to differentiate between the various causes should be quick, easy, cheap, specific, not too bothersome for the patient, and noninvasive or minimally so. Urodynamic evaluation is the gold standard for diagnosing bladder outlet obstruction (BOO) but presents some inconveniences such as embarrassment, pain, and dysuria; furthermore, 19% of cases experience urinary retention, macroscopic hematuria, or urinary tract infection. A greater number of resources in the diagnostic armamentarium could increase the opportunity for selecting less invasive tests. A number of groups have risen to this challenge and have formulated and developed ideas and technologies to improve noninvasive methods to diagnosis BOO. These techniques start with flowmetry, an increase in the interest of ultrasound, and finally the performance of urodynamic evaluation without a urethral catheter. Flowmetry is not sufficient for confirming a diagnosis of BOO. Ultrasound of the prostate and the bladder can help to assess BOO noninvasively in all men and can be useful for evaluating the value of BOO at assessment and during treatment of benign prostatic hyperplasia patients in the future. The great advantages of noninvasive urodynamics are as follows: minimal discomfort, minimal risk of urinary tract infection, and low cost. This method can be repeated many times, permitting the evaluation of obstruction during clinical treatment. A urethral connector should be used to diagnose BOO, in evaluation for surgery, and in screening for treatment. In the future, noninvasive urodynamics can be used to identify patients with BOO to initiate early medical treatment and evaluate the results. This approach permits the possibility of performing surgery before detrusor damage occurs.
Current Urology Reports, 2003
Throughout the past decade, several minimally invasive therapies for benign prostatic hyperplasia (BPH) have emerged to challenge transurethral prostatectomy (TURP) in efficacy and safety. This review compares high- and lowenergy transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA) of the prostate with TURP in clinical efficacy and safety. In reducing benign prostatic hyperplasia (BPH) symptoms, TUNA and TUMT are, at best, equal to TURP. However, the effects of TUMT and TUNA on objective measures of obstructive uropathy are minimal and less durable compared with TURP. The sole determinant of when and how to treat a patient with BPH is not solely a therapy’s clinical effectiveness. Other multiple factors must be considered, including safety, adverse effects, sexual function, and cost. The role of TUNA and TUMT lies in offering a cost-effective alternative for achieving substantial improvement in quality of life at an acceptable risk level for treatment-associated complications.
Introduction: The Aim of this study was to investigate the efficacy of the new bipolar radiofrequency prostate thermotherapy method for those with high potential surgical risk and also for patients with a chronic catheter. Material and Methods: 103 patients attending our clinic due to BPO and related complaints with high ASA score had outcomes after the procedure recorded prospectively and investigated retrospectively. Qmax, prostate volume, IPSS score, quality of life score, and presence of catheters were recorded before the procedure and analyzed with the outcomes after the procedure. Results: The ASA scores were calculated as 3.0 ± 1.0 (IQR). Before the procedure, Qmax values (mean (SD)) were 5.11 ± 5.37 ml/s, while in the 6th month after the procedure Qmax values were identified as 10.45 ± 3.8 ml/s (p < 0.001). Of 53 patients (55.2%) with chronic catheters who could not be operated, 30 (61.2%) no longer required urinary catheter. Conclusion: Bipolar RF thermotherapy appears to be an effective method for patients with BPO who cannot be operated. Due to the surgical risks of patients dependent on the catheter in spite of receiving medical treatment, it is a good alternative to remove catheter dependence. It may be one of the methods that should be remembered, especially in this patient group.