Systematic review and meta-analysis of Transurethral Needle Ablation in symptomatic Benign Prostatic Hyperplasia

Abstract

BackgroundBenign prostatic hyperplasia (BPH) constitutes a major clinical problem. Minimally invasive therapies for the treatment of symptomatic BPH include Transurethral Needle Ablation (TUNA), but it is unclear what impact this technique has on the disease and its role among other currently available therapeutic options. The objective of this study is to ascertain the efficacy and safety of TUNA in the treatment of BPH.MethodsSystematic review of the literature until January 2005 and meta-analysis of clinical studies assessing TUNA in symptomatic BPH. Studies were critically appraised. Estimates of effect were calculated according to the random-effects model.Results35 studies (9 comparative, 26 non-comparative) were included. Although evidence was limited by methodological issues, the analysis of relevant outcomes indicates that while TUNA significantly improves BPH parameters with respect to baseline, it does not reach the same level of efficacy as TURP in respect to all subjective and objective variables. Further, its efficacy declines in the long-term with a rate of secondary-treatment significantly higher than of TURP [OR: 7.44 (2.47, 22.43)]. Conversely, TUNA seems to be a relatively safe technique and shows a lower rate of complications than TURP [OR:0.14 (0.05, 0.14)] with differences being particularly noteworthy in terms of postoperative bleeding and sexual disorders. Likewise, TUNA has fewer anesthetic requirements and generates a shorter hospital stay than TURP [WMD: -1.9 days (-2.75, -1.05)]. Scarce data and lack of replication of comparisons hinder the assessment of TUNA vs. other local therapies. No comparisons with medical treatment were found.ConclusionThe body of evidence on which TUNA has been introduced into clinical practice is of only moderate-low quality. Available evidence suggest that TUNA is a relatively effective and safe technique that may eventually prove to have a role in selected patients with symptomatic BPH. TUNA significantly improves BPH parameters with respect to baseline values, but it does not reach the same level of efficacy and long-lasting success as TURP. On the other hand, TUNA seems to be superior to TURP in terms of associated morbidity, anesthetic requirements and length of hospital stay. With respect to the role of TUNA vis-à-vis other minimally invasive therapies, the results of this review indicate that there are insufficient data to define this with any degree of accuracy. Overall cost-effectiveness and the role of TUNA versus medical treatment need further evaluation.

1974 Population Based Trends in the Surgical Treatment of Benign Prostatic Hyperplasia

“…We could not examine trends in the use of transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA) of the prostate, because the SASD and SID databases do not reliably capture these office based procedures. 6 However, TUMT and TUNA offer less durable results, 21,22 so a clinical decision for a patient with symptomatic LUTS first involves the decision for an operative versus office based procedure and then secondarily a decision for or against laser prostatectomy. Therefore, a comparison of laser prostatectomy and TURP more accurately reflects the real clinical decision-making process.…”

Surgical management of benign prostatic hyperplasia

“…Uz pomoć optičkog instrumenta u uretru se uvede monopolarni kateter koji na vrhu ima dvije igle kojima se uz pomoć električne energije proizvodi toplina u tranzicionalnoj zoni, čuvajući sluznicu uretre, čime dolazi do koagulacijske nekroze. Pogodna je za pacijente kod kojih nije uspjela medikamentozna terapija, koji nisu skloni većem zahvatu te s prostatom do 60 g. To je zahvat koji ima sve pogodnosti dnevne kirurgije u smislu kratke hospitalizacije i niskog morbiditeta, ali mu nedostaje dugoročna efikasnost i dugotrajnost kao kod TURP-a 27,28 .…”

2010 Update: Guidelines for the management of benign prostatic hyperplasia

“…[66][67][68] TUNA is not an insurable service anywhere in Canada at this time; patients are required to pay for this procedure.…”