Transurethral Needle Ablation of the Prostate: Outcome at 1 Year

Holmes, Mark A.; Stewart, Jeffrey; Boulton, J.B.; Chambers, Rachel M.

doi:10.1089/end.1999.13.745

Cited by 14 publications

(10 citation statements)

References 13 publications

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“…In contrast, while median lobe hypertrophy was generally deemed to be an exclusion criterion for TUNA, 2 studies [ 40 , 45 ] typically included this group of patients. Thirteen studies [ 26 , 28 - 30 , 33 , 35 , 36 , 38 , 41 , 43 , 46 , 48 , 49 ] furnished data on baseline prostatic size, with the mean value being 45.5 ± 8.8 (range:38–66). Only 3 studies [ 42 , 44 , 49 ] had follow-up periods exceeding 2 years.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2006

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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.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2006

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“…However, when compared with TURP, it induces a significantly lower decrease in the parameters of obstruction [13]. A statistically significant increase in flow rateand fall in symptom scores have been observed 1 year after TUNA [14]. However, these authors found that 24% of patients treated with TUNA were not satisfied after the procedure and underwent a second endoscopic operation [14].…”

Section: Discussionmentioning

confidence: 99%

“…A statistically significant increase in flow rateand fall in symptom scores have been observed 1 year after TUNA [14]. However, these authors found that 24% of patients treated with TUNA were not satisfied after the procedure and underwent a second endoscopic operation [14]. Other authors observed subjective and objective improvements after a 2-year follow-up [15].…”

Section: Discussionmentioning

confidence: 99%

Pressure-Flow Studies in Men with Benign Prostatic Hypertrophy before and after Treatment with Transurethral Needle Ablation

et al. 2001

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Background/Aims: In this study we wanted to examine the effects that transurethral needle ablation (TUNA) might have on the urodynamic characteristics of bladder outlet obstruction and to evaluate the clinical changes and the safety profile in patients undergoing the TUNA procedure, including the effects on erectile and ejaculatory function. Materials and Methods: We evaluated 24 patients, aged between 66 and 81 (mean 73.4) years with a mean prostatic volume of 57 ± 15 ml. Before treatment, the clinical history was collected, then prostate-specific antigen (PSA) analysis, digital rectal examinations, I-PSS and quality-of-life (QOL) tests, uroflowmetry with residual volume, and pressure-flow studies were performed in all patients. After treatment, all the patients were evaluated at 6, 12 and 24 months by the same parameters. Results: After treatment, the I-PSS and QOL scores were considerably improved, and the mean flow rate and the residual volume were also improved. The serum PSA level remained unchanged. The prostatic volume was almost unchanged, and pressure-flow studies showed a reduction in the mean opening pressure and detrusor pressure at maximum flow after treatment. None of the patients complained of alterations in sexual activity nor retrograde ejaculation. Conclusions: Our study confirms that in patients with benign prostatic hyperplasia, the TUNA procedure results in no major complications and in significant clinical improvements. There was an improvement in the subjective and objective variables, such as symptom scores and frequency-volume charts and, in the majority of patients, subjective and objective improvements were sustained for the duration of this study, which included a 2-year follow-up with pressure-flow studies. From our experience we can say that the ideal candidate for TUNA treatment should be younger than 70 years, with a prostatic volume of <60 cm H₂O, with a baseline detrusor pressure at maximum flow of <60 cm H₂O, with a pretreatment residual volume of <100 ml and with a QOL score of <5.

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“…The majority of data derive from 26 noncomparative studies [2][3][4][6][7][8]10,12,14,17,[20][21][22][23][24][25][26][27], the shortest follow-up being 3 months (650 patients) and the longest being 5 years (394 patients). Improvement of LUTS is stable over time with an average of 53% improvement at 3 months, 59% at 1 year and 51% at 5 years [19 ].…”

Section: Clinical Outcomementioning

confidence: 99%