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Transurethral needle ablation of the prostate: A prospective study with a 2-year follow-up
Abstract
Introduction: Transurethral needle ablation of the prostate (TUNA) is used to deliver low-level radiofrequency through a catheter device equipped with adjustable needles placed in selected prostatic tissue areas. TUNA ablation produces necrosis by heating tissue to 110 °C. The objectives of this study were to determine the clinical efficacy of TUNA for the treatment of symptomatic BPH and to compare it with TURP. Patients and methods: From April 1994 to May 1996, 51 patients (mean age 66.2 years, range 58-71; mean prostatic weight 53.3 g. range 25-85) were treated using TUNA; 51 patients of similar age and prostatic weight underwent TURP. The assessment variables were the IPSS, quality-of-life, uroflow, post-void residual volume (PVR), TRUS, urine culture and measurements of PSA and creatinine. Results: The values at various times after treatment were as given in the table. TUNA [mean (SD)] TURP [mean (SD)] Follow-up 0 6 12 24 0 6 12 24 (months) IPSS 20.3 11.7 12.0 5.4 32.0 5.2 7.3 3.8 (7) (8) (8) (4) (4) (4) (3) (1) QOL 4.6 2.6 2.8 1.8 5.1 2.3 1.6 1.5 (1) (1) (1) (1) (1) (1) (1) (1) Qmax (mL/s) 7.8 13.6 13.8 14.4 7.0 23.6 28.1 27.1 (3) (5) (4) (4) (3) (5) (4) (4) PVR (mL) 166 92 80 32 130 30 35 40 (105) (149) (99) (15) (90) (45) (40) (10) PSA(ng/mL) 5.1 4.7 4.7 4.2 5.6 1.2 1.2 1.3 No ejaculatory dysfunction was reported after TUNA, compared with 68% after TURP, and no blood transfusion was required after TUNA, compared with 24% after TURP. The mean hospital stay was 1.2 days after TUNA and 3.5 days after TURP. Short-term failure occurred in 2% after TUNA. Conclusions: In our experience, TUNA produced minimal morbidity with no serious complications. At 24 months, patient satisfaction was comparable in both groups.
There has been considerable interest over the past decade in the development of nonsurgical and minimally invasive therapies for benign prostatic hyperplasia (BPH), especially for patients who do not desire surgery or for those who are poor surgical candidates. Transurethral resection of the prostate (TURP) remains the most effective and durable endoscopic therapy for symptomatic BPH, but it has been associated with potentially significant morbidity (1). A meta-analysis of patients undergoing TURP estimated that 30.7% of patients experienced some morbidity or complication (2). Borboroglu et al. reported on a series of 520 patients who underwent TURP from 1990 to 1998 and had immediate and late complication rates of 10.8% and 8.5%, respectively (3). Approximately 15% of patients require a second intervention within 10 yr of undergoing TURP (4). The combination of patient demands and socioeconomic concerns has spurred the increased interest in less invasive, less morbid treatment options for BPH. Medical therapies such as α-blockers and 5α-reductase inhibitors as well as balloon dilation, urethral stents, and thermal therapies have been the focus of attention. Various thermal strategies have been investigated as minimally invasive procedures for BPH, including the use of microwave, laser, high-intensity focused ultrasound, and radiofrequency (RF) energy to deliver heat to the interstitium of the prostate. All thermotherapies, regardless of the form of energy used, achieve necrosis of the prostate by raising the temperature of the tissue to above 60° C (5). Transurethral needle ablation of the prostate (TUNA) uses low-energy RF delivered directly into the prostate to produce controlled necrosis of the obstructing adenoma. RF has been used successfully in other medical applications such as to ablate accessory atrioventricular bundles in Wolff-ParkinsonWhite syndrome and to destroy neoplastic hepatocellular tumors and anomalous neural tissue (6–8). For the past decade, TUNA has been investigated as a minimally invasive alterative to TURP for the management of symptomatic BPH. The precision of the RF delivery and the reproducible necrosis have made TUNA an attractive alternative to more invasive surgery.
Background: As the age advances benign prostatic hyperplasia occurs in almost all men. BPH produces symptoms mostly after 50years of age. Non surgical/ conservative management for bladder outflow obstruction mainly due to obstructive prostate includes selective alpha adrenergic blockers and alpha 1 reductase inhibitors. They have significant role but only in patients who have small prostate or who are waiting for surgery. However 30% of men eventually require surgery for BPH. Because of high risk of morbidity and mortality to elderly patients undergoing prostate surgery, the search for a procedure with minimal associated risks has continued. Therefore different procedures have been tried. Among surgical treatment for the disease, TURP has a definite edge over open procedures and has become a reference standard for prostate surgery. Study Design: Retrospective study Place and Duration of Study: This study was conducted at DHQ Hospital Abbottabad from 1998-2001. Patients and Methods: Total 133 patients were treated during this period. Patients of all ages were included. The patients were divided into 04 age groups. Patients were investigated with physical examination, ultrasonography, ECG, Chest X-ray, Blood CP, Urea/creatinine. Standard procedure with 24 Fr. Resectoscope was used with cutting loop. Patients were followed up post operatively and complications noted. Results: The common age group was 61-70 years (51%). Size of prostate gland was 60-80gms in (32%) cases. Bleeding was the most common complication (9%). Conversion to open was in 02 cases (1.5%). Myocardial infarction occurred in 04 cases which resulted in death of these patients postoperatively. Conclusions: BPH produces symptoms mostly after 50years of age. Nearly 70% of 70 years old men have BPH. However 30% of men eventually require surgery for BPH. Among surgical treatment for the disease, TURP has a definite edge over open procedure. It has very low complications in good hands. TURP has become a reference standard for prostate surgery.
Die Behandlung der Benignen Prostata Hyperplasie (BPH) mit der transurethralen Nadelablation der Prostata (TUNA) hat sich nach Zulassung durch die FDA in den Vereinigten Staaten etabliert. Deutschland hinkt dieser Entwicklung hinterher, wenngleich auch hier ein Wandel bereits zu erkennen ist. Kritiker bemängeln häufig den fehlenden Nachweis der Langzeitergebnisse. Die vorliegende Arbeit stellt eine Übersicht klinischer Studien mit dem TUNA-Verfahren dar, die Ergebnisse werden dargestellt und diskutiert.
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