Transurethral needle ablation for benign prostatic hyperplasia: 12-month results of a prospective, multicenter U.S. study

Trans - Perineal laser ablation of the prostate in high surgical risk patients affected by severe lower urinary tract symptoms related to benign prostatic obstruction

BACKGROUND

In our study, we aimed to test the efficacy and safety of Trans-Perineal Laser Ablation of the prostate (TPLA®) in the surgical treatment of high-risk Benign Prostatic Obstruction (BPO) patients.

METHODS

We defined a high-risk BPO patient as an elderly man affected by severe comorbidities, among which coagulation issues due to pre-existent medications or diseases. From October 2020 to June 2022, we prospectively enrolled high-risk patients affected by a moderate to severe and/or complicated BPO condition. The analysis of the efficacy of the Trans-Perineal Laser Ablation was defined as the primary endpoint of the study. Secondary endpoints were post-operative surgical complications and patient-reported quality of life.

RESULTS

Globally, 40 consecutive patients were enrolled. Median (IQR) age was 80 (72.5-84) years. Median Charlson Comorbidity Index was 6 (5-7). Median prostate volume was 38 (30.5-73) cc. In all cases, a TPLA® procedure was performed under local anesthesia, and patients being discharged within the same day of the procedure. A progressive reduction of median prostate volumes was reported at 3 and 6 months post-operatively, compared to baseline [38 (30.5-73) vs 35 (26-49) vs 34 (28-49) cc, p < 0.001]. Median International Prostate Symptom Score (IPSS) improved accordingly [25 (19-30) vs 10.5 (7.5-13) vs 8 (6-11.5), p < 0.001]. A permanent bladder catheter was successfully removed in 13 out of 23 (56.5%) cases. Within 90 days from surgery, 19 (47.5%) patients experienced at least one surgical complication. According to the Clavien-Dindo classification, complications were classified as grade I in 16 (40%) cases, grade II in 9 (22.5%), and grade III in 1 (2.5%). We did not observe any grade IV or V complications.

CONCLUSIONS

The Trans-Perineal Laser Ablation of the Prostate is a feasible, safe, and effective Minimally Invasive Surgical Technique, when offered to elderly, high-risk patients affected by severe Benign Prostatic Obstruction.

A systematic review and network meta-analysis comparing Rezūm with transurethral needle ablation and microwave thermotherapy for the management of enlarged prostate

Objectives

We aim to compare efficacy and safety of water vapour therapy (Rezūm), transurethral needle ablation (TUNA) and transurethral microwave therapy (TUMT) for treating men with moderate to severe benign prostatic hyperplasia (BPH) symptoms.

Materials

PubMed/MEDLINE, EMBASE and Cochrane Library were searched from inception to 30 July 2023, followed by reference searching and dual-independent study selection. We analysed only randomized clinical trials. RoB-2, NIH-quality assessment tool and GRADE guidelines were used for quality-of-evidence (QoE) assessment. Relevant prospective studies without a critical risk-of-bias were included.

Results

At 12 months, Rezūm showed similar efficacy to TUNA and TUMT for improvement in International Prostate Symptoms Score - Rezūm versus TUMT: 1.33 points (95% CI: -1.66 to 4.35) favouring TUMT (QoE: Moderate) and Rezūm versus TUNA: 0.07 points (95% CI: -3.64 to 3.88) favouring TUNA (QoE: Low). Rezum had similar outcomes to TUNA and TUMT for Maximum Peak-Flow Rate (Qmax): Rezūm versus TUMT: 1.05 mL/s (95% CI: -4.88 to 2.82) favouring Rezūm (QoE: Low) and Rezūm versus TUNA: 0.37 mL/s (95% CI: -4.61 to 4.21) favouring TUNA (QoE: Low). Furthermore, post-void residual volume (PVR) comparisons demonstrated that Rezūm was similar, or inferior to other techniques at 12 months - Rezūm versus TUMT: 11.20 mL (95% CI: -32.40 to 10.30) favouring TUMT (QoE: Low) and Rezūm versus TUNA: 24.10 mL (95% CI: 2.81 to 45.10) favouring TUNA (QoE: Low). Rezūm also had a similar surgical retreatment rate with TUMT and TUNA up to 3-years - TUMT versus Rezūm RR: 1.21 (95% CI: 0.20 to 15.90) (QoE: Low) and TUNA versus Rezūm showed RR: 1.81 (95% CI: 0.2 to 24.60) (QoE: Low). In the first 12 months after treatment, Rezūm had a higher rate of serious adverse events (Clavien-Dindo ≥ Grade 3) than TUMT and TUNA. TUMT versus Rezūm with RR = 0.53 (95% CI: 0.13 to 3.14) (QoE: Low) and TUNA versus Rezūm with RR = 0.38 (95% CI: 0.04 to 3.49) (QoE: Low).

Conclusions

Moderate to weak evidence suggests that Rezūm is not superior to TUNA and TUMT in all domains studied.

Ejaculation physiology and dysfunction after BPH surgery: the role of the new MISTs

BACKGROUND

Human ejaculation can be defined as a complex and still largely unknown function. Since decades, Benign Prostatic Hyperplasia (BPH) surgery-associated loss of antegrade ejaculation has been reported as a bother by many patients. New technologies and modified surgical techniques were developed, to reduce the impact of ejaculatory dysfunction on patients' perceived quality of life. Recently, the emerging of the new Minimally Invasive Surgical Techniques (MISTs) empowered the urological surgeons with the technological means to introduce the ejaculation-sparing principles into everyday clinical practice.

METHODS

Our paper was conceived as a state-of-the-art analysis about the anatomical and physiological premises of the human ejaculation and their clinical application in the field of ejaculation-sparing surgery for the treatment of Lower Urinary Tract Symptoms (LUTS). Moreover, we proposed an innovative physiological model for antegrade ejaculation.

RESULTS

We analysed the elements of the "ejaculatory apparatus" from an anatomical point of view. We investigated the physio-pathological models of the human ejaculation, from the classical "combustion chamber" paradigm to the new evidences by which it could be overcome. Finally, we provided a synthetic literature review about the ejaculation-sparing techniques for BPH surgery. Particularly, we distinguished them between classical techniques, modified for ejaculation-preserving purposes, and the new MISTs, characterized by the introduction of new technologies and different treatment modalities.

CONCLUSIONS

Modified surgical techniques and new technologies opened new perspectives about human ejaculation. Previously established functional paradigms were questioned and overcome by recent clinical evidence. The new MISTs gained a prominent role in the process, opening a whole new era for BPH surgery.

Evaluation of outcome of transurethral needle ablation for treating symptomatic benign prostatic hyperplasia: A 10-year experience

Aim:

The aim of this study is to report our 10-year experience with transurethral needle ablation (TUNA) to evaluate its outcome on long-term basis.

Patients and Methods:

A total of 351 patients’ records who underwent TUNA procedure for the management of benign prostatic hyperplasia were reviewed. The International Prostate Symptom Score (IPSS) and peak urinary flow rate were evaluated before the procedure, at 3 and 6 months postoperatively, and then yearly for 10 years. For patients complaining of de novo erectile dysfunction, the International Index of Erectile Function-5 was evaluated. Postoperative complications, number of patients who required additional therapeutic modality/other TUNA sessions, or those dropped out during follow-up were all recorded.

Results:

Three hundred and fifty-one patients who underwent TUNA with fulfillment of our selection criteria were included in the study. The yearly records of included patients showed that patients’ baseline IPSS was significantly improved all over the follow-up years. Similarly, the maximum flow rate of the patients was significantly improved during the next 8 years. About 96.4% of patients who underwent TUNA did not require additional therapeutic modality/other TUNA sessions during the 1^st-year follow-up. However, by 10 years, 26.4% of patients were offered another TUNA session and shifted to either medical therapy or other minimally invasive therapies. Mild hematuria was the most common complication (85.7%). Urinary retention, urethral stricture, and de novo erectile dysfunction were developed in 15.1%, 1.7%, and 6.8% of patients, respectively. There were no cases of retrograde ejaculation.

Conclusion:

TUNA can be considered as a relatively effective technique with a good safety profile. The current study demonstrated both significant subjective and objective improvements over 10 and 8 years of follow-up, respectively. It can be considered as a preferable option for patients who prefer surgical option with preservation of their sexual function and fertility.

Clinical study on the application of a 2-μm continuous wave laser in transurethral vaporesection of the prostate

The present study aimed to evaluate the method and clinical effects of transurethral dividing vaporesection of the prostate in the management of benign prostatic hyperplasia (BPH) using the RevoIix 70 W 2-μm continuous wave (cw) laser. A total of 155 BPH patients were treated transurethrally under epidural or sacral anesthesia using the dividing vaporesection technique. Of these, 80 had a prostate volume of ≤80 ml and 75 had a prostate volume of >80 ml. Pre- and post-operative data were evaluated for prostate-specific antigens (PSAs), post-void residual volume (PVR), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS) and quality of life (QoL). Statistical analyses were performed using the SPSS 16.0 software. Treatment effectiveness evaluations were also conducted. In the ≤80 ml prostate volume group, the mean PSA level decreased from 3.8±0.9 to 2.6±1.3 ng/ml. The PVR, mean Qmax, IPSS and QoL score improved significantly (P<0.05) in each group but no statistically significant difference was identified between the two groups. With a shorter surgery duration, safe use and high cutting efficiency and rapid vaporization ability, the 2-μm laser vaporesection technique shows superiority compared to standard techniques in the treatment of BPH.

[Treatment of benign prostatic hyperplasia by Prostiva(®): about a series of 76 cases]

PURPOSE

To evaluate the efficacy and morbidity of BPH treatment by radiofrequency in the general population and attempt to identify factors of prognostic value for this technique.

METHODS

This retrospective study examined 76 consecutive patients of mean age 68.9 years with symptomatic BPH in failure of medical treatment and treated at University Hospital of Caen between April 2004 and October 2008. Urine status was assessed before and after treatment with radiofrequency by the international prostate symptom score (IPSS), the quality of life (QOL) score related to urinary symptoms, the measurement of maximum urinary flow (Qmax) and residual postvoid volume (RPV). Erectile function was assessed by the International Index of Erectile Function (IIEF-5). The primary endpoint was treatment failure by radiofrequency regarded as the reintroduction of medical treatment or the need for surgical treatment. The secondary endpoints were the improvement of IPSS and QOL score, Qmax and RPV. Morbidity per and post-operative was also evaluated.

RESULTS

A significant improvement in voiding status was observed with an average IPSS score from 24.7 to 15.1 (P<0.0001), and a QOL score from 5.2 to 2.9 (P<0,0001) in all patients. The Qmax and the RPV were significantly improved from 8.6 to 13.1ml/s (P<0.0001) and 177 to 100ml (P=0.0002) respectively. The IIEF-5 score was improved from 9.04 to 9.97 (P=0.0164). Twenty-five percent of acute urinary retention, 7.9% of haematuria and 1.3% of prostatitis were observed postoperatively. The overall retreatment rate was 46% after 14.6 months mean follow-up. When stratified into groups, patients with the inclusion criteria to this treatment showed a treatment rates of 34.8% after 16.2 months mean follow-up against 51% after 13.8 months of monitoring patients outside the inclusion criteria. Without showing significant difference between retentionist and no retentionist concerning subjective and objective parameters, the rate of retreat was more important for retentionist (51.2% after 11.8 months of mean follow against 39.4% after 18.4 months) with a significant difference on the actuarial cumulative survival curve without reprocessing. There was no significant difference found in patients with a median lobe. The results showed an improvement in Qmax significantly greater in the group with prostates less than 60 g without being able to demonstrate significant differences in other parameters. The retreatment rates in this group was 44.4% after 14.7 months of follow-up against 53.8% after 13.8 months of follow-up in the group of patients with prostate over 60 g. Moreover, the irritative component made a better initial response to treatment with a need for retreatment delayed compared to the group of patients with obstructive symptom, without noting significant differences in terms of improvement of objective and subjective parameters. The rate of retreatment was 63.6% after 16.4 months of mean follow and 51.6% after 11.2 months in the "obstructive" group.

CONCLUSION

High rates of reprocessing are observed in the treatment of BPH by radiofrequency if inclusion criteria are not respected.

Initial human feasibility study of DC ablation as a treatment for benign prostatic hyperplasia: 6 month follow-up data

Direct current (DC) ablation is a novel non-thermal technology that causes focused coagulative necrosis in the lateral lobes of the prostate to treat benign prostatic hyperplasia (BPH). The necrosis is caused by a zone of non-physiologic pH which is created in a predictable pattern around each electrode in which a direct current is applied during treatment. The objective of this study was to optimize treatment parameters and assess treatment tolerability using transurethral DC ablation as an office-based treatment for BPH.

Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients

Symptomatic benign prostatic hyperplasia (BPH) typically occurs in the sixth and seventh decades, and the most frequent obstructive urinary symptoms are hesitancy, decreased urinary stream, sensation of incomplete emptying, nocturia, frequency, and urgency. Various medications, specifically 5-α-reductase inhibitors and selective α-blockers, can decrease the severity of the symptoms secondary to BPH, but prostatectomy is still considered to be the traditional method of management. We report the preliminary results for two patients with acute urinary retention due to BPH, successfully treated by prostate artery embolization (PAE). The patients were investigated using the International Prostate Symptom Score, by digital rectal examination, urodynamic testing, prostate biopsy, transrectal ultrasound (US), and magnetic resonance imaging (MRI). Uroflowmetry and postvoid residual urine volume complemented the investigation at 30, 90, and 180 days after PAE. The procedure was performed under local anesthesia; embolization of the prostate arteries was performed with a microcatheter and 300- to 500-μm microspheres using complete stasis as the end point. One patient was subjected to bilateral PAE and the other to unilateral PAE; they urinated spontaneously after removal of the urethral catheter, 15 and 10 days after the procedure, respectively. At 6-month follow-up, US and MRI revealed a prostate reduction of 39.7% and 47.8%, respectively, for the bilateral PAE and 25.5 and 27.8%, respectively, for the patient submitted to unilateral PAE. The early results, at 6-month follow-up, for the two patients with BPH show a promising potential alternative for treatment with PAE.

[Radiofrequency interstitial tumor ablation (RITA) for the treatment of localised prostate cancer]

Radiofrequency ablation produces an irreversible destruction of prostate tissue since it reaches temperatures of 110 degrees C that leads the tumour into coagulative necrosis and, based on preliminary studies, it has shown to be a safe therapeutical alternative for localised prostate cancer. It is a non-invasive technique with scarce complications which is especially attractive for those patients whose co-morbidity precludes them from having any others procedures that require general anaesthesia or that make them to be admitted. Another valuable aspect of this treatment modality is that treatment times are short (less than 10 minutes), and controlled lesions can be predictably generated, as well as it is a feasible technique by most urologists since it requires only basic imaging experience and it could be also repeated at any time if needed. However, despite these promising results, long term follow-up are needed before conclusions about the efficacy of RITA can be drawn and, therefore, before setting its role in localised prostate cancer treatment.

Evidence-based guidelines for the management of lower urinary tract symptoms related to uncomplicated benign prostatic hyperplasia in Italy: updated summary

BACKGROUND AND SCOPE

Despite the high prevalence and huge socio-economic impact of benign prostatic hyperplasia (BPH) in Italy, no national guidelines have been produced so far. This is a summary of the first Italian guidelines on the diagnosis and treatment of lower urinary tract symptoms (LUTS) related to uncomplicated BPH, prepared by a multidisciplinary panel under the auspices of the Italian Association of Urologists and introduced in Italy in 2003. An update compiled by the authors is also included.

METHODS

Relevant papers published from 1998 to 2003 (updated to 2006) were identified through a structured literature review and the quality of evidence presented therein was graded according to the Centre for the Evaluation of Effectiveness in Health Administration (CeVEAS) system. Recommendations were based on evidence from the literature, but also on feedback from practitioners and specialists. MAIN FINDINGS/RECOMMENDATIONS: Given the prevalence of BPH, all men aged > or = 50 years of age should be asked about LUTS and informed about disease characteristics and therapeutic options, while sexual function should always be assessed in patients with severe and long-standing LUTS. Initial assessment should include medical history (including drug and co-morbidity history), digital rectal examination, urinalysis, International Prostate Symptom Score-Quality of Life (IPSS-QoL) and a voiding diary, while prostate-specific antigen (PSA) and measurement of prostate volume by suprapubic ultrasonography are indicated in fully informed patients with a life expectancy of > or = 10 years in whom BPH progression could influence treatment choices. QoL considerations should dictate whether to start active treatment. When QoL is not affected by LUTS, watchful waiting is indicated if symptoms are mild, acceptable if they are moderate. When QoL is affected, medical therapy with alpha1-blockers or 5alpha-reductase inhibitors (the latter indicated in patients with increased prostate volume) is appropriate. Combined therapy with alpha1-blockers + 5alpha-reductase inhibitors should only be considered in patients at high risk for progression (prostate volume > 40 mL or PSA > 4 ng/mL), since the incremental cost of combination therapy vs. monotherapy with alpha1-blockers or finasteride is prohibitive. Selection of the type of surgery should be based on the surgeon's experience, the presence of co-morbid conditions and the size of the prostate. Open prostatectomy and transurethral resection of the prostate (TURP) are recommended in patients with acute or chronic retention of urine, and acceptable in obstructed patients with moderate/severe symptoms and worsened QoL. Transurethral incision of the prostate (TUIP) is acceptable when prostate volume is < or = 30 mL. Holmium laser enucleation of the prostate (HoLEP) may be proposed to motivated patients where expert surgeons are available. Transurethral microwave thermotherapy (TUMT) or transurethral needle ablation (TUNA) may be proposed to motivated patients who prefer to avoid surgery and/or do not respond to medical treatment. The possible effects of medical or surgical treatments on sexual function should always be discussed.

CONCLUSIONS

These guidelines are intended to provide a framework for health professionals involved in BPH management in order to facilitate decision-making in all areas and at all levels of healthcare.

Durability and Cost-Effectiveness of Transurethral Needle Ablation of the Prostate as an Alternative to Transurethral Resection of the Prostate When α-Adrenergic Antagonist Therapy Fails

PURPOSE

We analyzed the adverse event profile, long-term efficacy and cost-effectiveness of transurethral needle ablation of the prostate for lower urinary tract symptoms associated with benign prostatic hyperplasia as an alternative to transurethral resection of the prostate in men with symptoms uncontrolled by medical therapy.

MATERIALS AND METHODS

A total of 71 men on a waiting list for transurethral resection of the prostate after failed medical therapy underwent transurethral needle ablation of the prostate. Symptom scores, uroflowmetry and residual urine were measured before and up to 10 years following treatment. Transrectal ultrasound and pressure flow studies were performed before, and 3 and 12 months following treatment, respectively. Treatment failure was defined as lower urinary tract symptoms progression requiring further therapy or associated with deteriorating quality of life assessment.

RESULTS

Apart from transient postoperative urinary retention, no significant treatment emergent adverse events due to transurethral needle ablation of the prostate were observed. Treatment failure occurred in 58 men (83%) at a median of 20 months. A total of 36 men (51%) underwent invasive treatment (transurethral resection of the prostate 33, bladder neck incision 2, microwave thermal ablation 1), 2 men (3%) were deemed unfit for anesthesia and now practice clean intermittent self-catheterization, 14 men (20%) reported improvement following resumption of treatment with an alpha-adrenergic antagonist after transurethral needle ablation of the prostate and 6 men (9%) have experienced deterioration in lower urinary tract symptoms with reduction in quality of life assessment (International Prostate Symptom Score 3 or greater) but have declined further intervention. There were 12 men (17%) who remained symptom-free up to 10 years after transurethral needle ablation of the prostate. The estimated additional cost of treatment for lower urinary tract symptoms per man treated with transurethral needle ablation of the prostate during the 10-year followup was $1,377.

CONCLUSIONS

Despite documented safety and lack of morbidity, the high re-treatment rate associated with transurethral needle ablation of the prostate renders it relatively expensive when viewed as a long-term alternative to transurethral resection of the prostate for the management of lower urinary tract symptoms associated with benign prostatic hyperplasia in men in whom medical therapy failed. Of men failing alpha-blockade therapy 20% will benefit from a combination of transurethral needle ablation of the prostate and alpha-blockade.

Transurethral needle ablation of the prostate

PURPOSE OF REVIEW

The review aims at reviewing the evidence published in the peer review literature or otherwise available with particular focus on articles published over the last 2 years on the transurethral needle ablation of the prostate in the treatment of benign prostatic hyperplasia. Prospective noncomparative and comparative studies as well as meta-analyses were considered. Information from the European Real Life database on transurethral needle ablation was also included.

RECENT FINDINGS

The evidence currently available confirms a clinically relevant improvement of lower urinary tract symptoms and quality of life. Impact on voiding dynamics including flow rates, detrusor pressure at maximum flow and postvoid residual, as well on prostate volume, remains marginal.

SUMMARY

All major guidelines in the management of lower urinary tract symptoms in patients with benign prostatic enlargement include transurethral needle ablation of the prostate as a valuable treatment option in patients with severe symptoms and low degree of bladder outlet obstruction, patients at high risk for surgery and patients who wish to avoid surgery or regional/general anaesthesia.

Erectile Dysfunction after PlasmaKinetic Vaporization of the Prostate: Incidence and Risk factors

PURPOSE

To determine the incidence of erectile dysfunction (ED) after PlasmaKinetic vaporization of the prostate (PKVP) using objective and subjective parameters and risk factors.

PATIENTS AND METHODS

A total of 153 men completed a questionnaire detailing perceived sexual dysfunction and underwent nocturnal penile-tumescence testing using the RigiScan for three consecutive nights 3 or 4 days preoperatively and 3 months postoperatively. The International Index of Erectile Function (IIEF)-5 scores were obtained preoperatively and postoperatively. Full details of each operation were recorded, including grams of tissue resected, operative time, any short-term complications, especially emphasizing capsular perforation, and concomitant diseases such as diabetes and hypertension. The association of risk factors with the development of ED after PKVP was assessed. Complete data were available for 103 men (67.3%). Their mean age was 62.1 years (range 48-83 years).

RESULTS

Postoperatively, 11 patients (10.6%) were found to have ED. Patients who developed ED postoperatively had a lower IIEF-5 score and penile-tumescence parameters preoperatively (for all parameters, P < 0.0001). As risk factors, diabetes, capsular perforation, and an IIEF-5 score <21 were found to be significant.

CONCLUSIONS

The incidence of ED after PKVP measured objectively was 10.6%. In the absence of the risk factors, PKVP is a safe therapeutic strategy with regard to sexual function.

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

BACKGROUND

Benign 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.

METHODS

Systematic 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.

RESULTS

35 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.

CONCLUSION

The 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.

Large Radiofrequency Ablation Lesions Can Be Created with a Retractable Infusion-Needle Catheter

BACKGROUND

Radiofrequency (RF) catheter ablation of ventricular tachycardia is sometimes limited by inadequate lesion depth. We report the use of a novel retractable needle-tipped electrode catheter with intramyocardial (IM) saline infusion and IM RF energy delivery to create large myocardial ablation lesions.

METHODS

The left ventricle was entered via the femoral artery in 6 and 11 anesthetized goats and swine (32-90 kg) with an 8-F electrode catheter with an extendable 27-gauge needle at the tip (modified for RF ablation by making the needle electrically active). The needle was advanced 5-7 mm intramyocardially and 0.9% saline was infused 1 mL/min x 60 seconds prior to, and throughout a 120-second application of RF via the active needle, with power titrated to 12 W for 9 lesions, and 30-40 W for 37 lesions, followed by a 120-second RF application using the 4-mm-tip electrode, with power titrated to achieve a 10-Omega decrease in impedance. Needle/saline lesions were compared to 18 standard 4-mm-tip control lesions (power titrated to < or =50 W, to achieve a 10-Omega impedance decrease or limited to 60 degrees Celsius) and to 17 irrigated 3.5-mm-tip lesions (power titrated to < or =50 W, temperature limited to 50 degrees Celsius, 30 mL/min infusion rate). Lesions were identified in the excised heart, fixed, serially sectioned from the endocardium, and digitally analyzed to calculate volume.

RESULTS

Lesions were homogeneous and had distinct borders. Compared to 4-mm-tip and irrigated-tip lesions, high-power needle/saline lesions were significantly deeper (13 +/- 2 vs 5 +/- 1 and 8 +/- 3 mm, P < 0.001), had significantly larger volumes (1,700 +/- 750 vs 240 +/- 170 and 750 +/- 650 mm(3), P < 0.001), and had larger cross-sectional area at each millimeter depth beyond the 1 mm (P < 0.01).

CONCLUSIONS

IM saline infusion and IM RF energy delivery markedly increase RF lesion size as compared to standard RF ablation and is feasible with a percutaneous catheter. This method warrants further investigation because of its potential clinical utility.

The association between lower urinary tract symptoms and sexual dysfunction: fact or fiction?

PURPOSE OF REVIEW

Both lower urinary tract symptoms and sexual dysfunction are common conditions in aging men. In the past few years, increasing attention has been paid to the question of whether these conditions are associated in any way. The conventional belief of the majority of urologists so far has been that the coexistence of these two conditions is coincidental. This review was conducted to discuss the recent literature on this issue. In addition we will concisely address the effect of the different treatment modalities on sexual function.

RECENT FINDINGS

Several trials were conducted recently to assess the association between lower urinary tract symptoms and sexual dysfunction. These trials all made use of self-reported questionnaires on urinary symptoms and sexual function sent to representative samples of the community. The occurrence of urinary symptoms appeared to be a risk factor for the development of erectile dysfunction, ejaculation disorder and decreased libido. Importantly, this association was independent of age and various co-morbidities.

SUMMARY

In contrast to long-established opinion, an age-independent association between lower urinary tract symptoms and sexual dysfunction was found in several recent population-based trials. The nature of this association, however, remains unclear. Future study is required to gain a better understanding of the possible underlying mechanisms.

Lasers for lower urinary tract symptoms secondary to benign prostatic hyperplasia: when is the fuss worth it?

In the recent past, several endoscopic procedures using laser technology have evolved for the treatment of benign prostatic hyperplasia. The term "laser treatment of the prostate" comprises a variety of different application systems, different laser wavelengths, and different surgical techniques to eliminate bladder outlet obstruction. The aim of laser prostatectomy is to be less invasive than transurethral electroresection, but equally effective. Promising short-term results led to a booming laser decade in the 1990s, stimulating the development of several devices. However, the emergence of medium-term data has shown that some of these techniques did not stand the test of time due to the lack of long-term efficacy, unacceptable morbidity, and high retreatment rates. Nevertheless, the results of transurethral resection of the prostate are challenged by some of the newer laser devices, putting the so-called "gold standard" into question.

Fact or fiction: what do the benign prostatic hyperplasia data tell us?

Benign prostatic hyperplasia (BPH) is the most common benign neoplasm in men. Our understanding of this condition has improved greatly over the years and recent advances have changed our approach to management. At the end of the 19th century, prostatic enlargement was treated effectively by bilateral orchidectomy. Unsurprisingly, this treatment option never gained widespread popularity. Less than 10 years ago, surgery and watchful waiting were the only considered treatment options for BPH. We now have a number of medical therapies and minimally invasive treatment options available that can effectively manage lower urinary tract symptoms secondary to benign prostatic obstruction. However, with increased choice comes the increased need for clarity in selection and application of these various treatment options. In the current environment of evidence-based clinical practice, awareness and interpretation of data from the numerous studies is paramount. The lessons learned from these trials should be reflected clearly in our practice, with clinical management based on fact, not fiction. In this review, we critically assess the available data and understanding of the management of BPH.

Transurethral needle ablation versus transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia: 5-year results of a prospective, randomized, multicenter clinical trial

PURPOSE

We report the 5-year efficacy and safety of transurethral needle ablation of the prostate (TUNA) compared to transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

A total of 121 men 50 years or older with LUTS secondary to BPH a minimum of 3 months in duration were enrolled in this prospective, randomized clinical trial at 7 medical centers across the United States. Of the participants 65 (54%) were randomly selected to receive TUNA and 56 (46%) were selected to receive TURP. International Prostate Symptom Score, quality of life, peak urinary flow rate, post-void residual urinary volume, and prostate size and configuration were evaluated before the procedure and then annually for 5 years after the procedure. Adverse events were also recorded throughout the study.

RESULTS

Improvement from baseline for TUNA and TURP retained statistical significance at each interval for International Prostate Symptom Score, quality of life and peak flow rate. Post-void residual volume was statistically significant at all time points for TURP and at year 5 for TUNA. The TURP group reported 41% retrograde ejaculation, while the TUNA group reported none. The incident of erectile dysfunction, incontinence and stricture formation was also greater in TURP than in TUNA cases with significantly fewer adverse events for TUNA than for TURP.

CONCLUSIONS

The results of this study demonstrate stable treatment outcomes after 5 years of followup and suggest that TUNA is an attractive treatment option for men with LUTS due to BPH.

Deep Myocardial Ablation Lesions Can Be Created with a Retractable Needle-Tipped Catheter

RF catheter ablation of ventricular tachycardia is sometimes limited by inadequate lesion depth. This study investigated the use of a retractable needle-tipped catheter to create deep RF lesions in vivo in porcine myocardium. An 8 Fr electrode catheter with an extendable 27-gauge needle at the tip was modified for RF ablation by embedding a thermocouple and attaching a pin connector. In three swine (32-58 kg) the left ventricle was entered via the femoral artery and endocardial contact was made. The needle was advanced 10 mm and 13 RF applications were made under a controlled temperature (90 degrees C x 120 s). Nine control lesions were made using a standard 4-mm tip catheter (60 degrees C x 120 s). The lesions were fixed, serially sectioned from the endocardium, digitally imaged, and quantified. Needle ablation lesions were deeper (10.15 +/- 0.77 vs 5.67 +/- 0.37 mm, P < 0.001) and more likely to be transmural (77 vs 11%, P = 0.008) than control lesions. The volume of control lesions, however, was larger (358.4 +/- 56.2 vs 174.7 +/- 18.6 mm(3), P = 0.002) due to a significantly larger cross-sectional area at the endocardium (0.548 +/- 0.04 vs 0.151 +/- 0.01 cm(2), P < 0.001). At depths > 6 mm, the needle electrode lesions had a greater cross-sectional area (0.136 +/- 0.01 vs 0.005 +/- 0.004 cm(2), P < 0.001). Catheter-based needle ablation is feasible and allows creation of deeper lesions that can be transmural. Although deep, the lesions had a small cross-sectional area such that precise targeting would be required for success.

Lower urinary tract symptoms and erectile dysfunction: co-morbidity or typical "Aging Male" symptoms? Results of the "Cologne Male Survey"

OBJECTIVES

Due to demographic developments in industrial nations, age-correlated diseases are becoming more important. From many epidemiological studies we know that the prevalence of benign prostatic hyperplasia (BPH) and the loss of erectile function (= erectile dysfunction or ED) increase with advancing age. Are these two illnesses related or/and independent?

METHODS

We mailed our newly developed and validated questionnaire on male erectile dysfunction (KEED), as well as a set of questions pertaining to voiding problems (IPSS), to a representative population sample of 8000 men from 30 to 80 years of age residing in the city of Cologne.

RESULTS

The responses included 4489 evaluable replies (56.1%). The response rates in the different age groups ranged from 41 to 61%. The mean age of the men who answered was 51.8 years. The overall prevalence of ED was 19.2% (n=862), with a steep age-related increase from 2 to 53%. Furthermore, 31.2% (n=1957) of all men complained of lower urinary tract symptoms (LUTS), the prevalence and the intensity of which increased with age. Interestingly, a high co-morbidity was found between ED and voiding problems. Prevalence of LUTS in men suffering from ED was about 72.2% (n=621) vs. 37.7% (1367) in men with normal erections. The odds ratio was evaluated with 2.11. The trivariate analysis showed that the occurrence of LUTS can be considered as an age-independent risk factor for the development of ED (p<0.001).

CONCLUSIONS

Even though the pathogenetic relationship between LUTS and ED is not yet completely understood, one has to postulate a direct association between these two typical symptom complexes in the aging male.

Changing aspects in the evaluation and treatment of patients with benign prostatic hyperplasia

Lower urinary tract symptoms are a common clinical symptom among men and a frequent reason for referring to a urologist. The most important information comes from the patient history because evaluation of symptoms is fundamental in the diagnosis and treatment planning for LUTS. Other aspects of the initial evaluation, such as the physical examination and initial laboratory values, can provide valuable additional information about the severity of the disease and the need for treatment. If treatment is warranted based on this information, additional diagnostic tests may be appropriate to set a pretreatment baseline, rule out other conditions, and plan treatment approach. Fortunately, a variety of effective medical and surgical treatments are available to treat this common disease.

Long-term evaluation of transurethral needle ablation of the prostate (TUNA) for treatment of symptomatic benign prostatic hyperplasia: clinical outcome up to five years from three centers

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.

Variations of transition zone volume and transition zone index after transurethral needle ablation for symptomatic benign prostatic hyperplasia

BACKGROUND

Transurethral needle ablation (TUNA) is less invasive than other therapies for benign prostatic hyperplasia (BPH) and produces coagulative necrosis within selected adenoma lesions. The action mechanism of TUNA is still obscure, even though many early studies have demonstrated good clinical results of TUNA. It is of interest and importance to know how TUNA influences the volume of the intraprostatic region responsible for bladder outlet obstruction in order to elucidate the anatomical action mechanism of TUNA.

METHODS

We retrospectively investigated postoperative variations in volumetric parameters of whole prostate volume (PV), transition zone volume (TZV) and transition zone index (TZI = TZV/PV) in 41 patients with symptomatic BPH who were treated with TUNA. The data were analyzed statistically in relation to the preoperative overall severity and postoperative therapeutic efficacy.

RESULTS

Both PV and TZV showed a significant decrease at 3 months after TUNA (P < 0.01) as did the symptom score, quality of life (QOL) score and functional variables, and a decreased level of PV and TZV was sustained until 12 months of follow-up when compared to the baseline (P < 0.01 at 6 months, not significant at 12 months). TZI also showed a similar pattern with a significantly decreased level until the postoperative 6th month (P < 0.05 at 6 months, not significant at 12 months). In 'moderate' cases, TZI achieved the minimum value (0.44 +/- 0.13, P < 0.05 compared to the baseline) at 3 months of follow-up, but the level immediately increased, while in 'severe' cases, TZI gradually decreased and achieved the minimum value (0.44 +/- 0.08, P < 0.05 compared to the baseline) at 12 months of follow-up. In the evaluation by postoperative therapeutic efficacy, there were no significant differences in PV, TZV and TZI between 'excellent and good' cases (E/G group) and 'fair and poor/worse' cases (F/P group) at the baseline or 3 months of follow-up. Both of the efficacy groups showed a significant decrease in PV, TZV and TZI at 3 months when compared to the baseline (P < 0.05). The mean decrease in TZI was significantly larger in the E/G group than in the F/P group (0.064 +/- 0.13 vs 0.027 +/- 0.12, P < 0.05).

CONCLUSION

Therapeutic efficacy of TUNA did not depend on the baseline value of PV, TZV and TZI, but on variation of a decrease in TZI during follow-up. Moreover, a slow and lasting decrease in TZI seemed to influence durability of the therapeutic efficacy of TUNA, which was clearly observed in 'severe' cases with a larger prostatic volume than in 'moderate' cases.

Histological changes of minimally invasive procedures for the treatment of benign prostatic hyperplasia and prostate cancer: clinical implications

PURPOSE

Benign prostatic hyperplasia (BPH) is near universal in aging men, creating tremendous costs in morbidity and surgical treatment. In the last decade numerous nonsurgical minimally invasive methods have emerged for ablation of prostatic tissue.

MATERIALS AND METHODS

We reviewed the recently published English language literature on minimally invasive techniques for treating BPH and cancer with an emphasis on histopathological findings.

RESULTS

We compared the spectrum of contemporary minimally invasive treatments for BPH and cancer, with an emphasis on histopathological results. Clinical results were summarized briefly for each treatment method. These procedures ablate tissue by thermal, cryogenic, chemical or enzymatic injury. The 5-year results for some techniques were promising, although long-term durability is still uncertain, and other methods were in preclinical or early clinical stages. Invariably the treated tissue was devitalized with a thin border of granulation tissue and fibrosis. These procedures have applications for BPH and prostate cancer, although some studies are limited to only 1 disease.

CONCLUSIONS

Minimally invasive procedures show promise of a durable replacement for surgical resection.

Benign prostatic hyperplasia

In both ageing men and women, there is an increasing incidence of lower urinary tract symptoms (LUTS) which are increasing. These infections have many possible causes, including smooth muscle dysfunction, neurological factors and benign prostatic hyperplasia. Up to 15% to 25% of men aged 50-65 years have LUTS of sufficient severity to interfere with their quality of life. Although benign prostatic hyperplasia is an important cause of these symptoms, and can have serious consequences, clinicians should be aware of these other causes so that the appropriate diagnosis is made before invasive treatments are started. New medical treatments, including alpha-adrenergic blocking agents and 5 alpha-reductase inhibitors mean that many men without complications such as infection, bleeding, or chronic retention, and with mild to moderate symptoms, should be managed in primary care. Combined local protocols between primary and secondary care will help to establish which men with persistent symptoms or complications need referral for a urological opinion to determine the need for further investigation and more invasive forms of management. We review the pathophysiology of the disease, and current approaches to investigation and management of this common problem.

Interstitial laser coagulation versus transurethral prostate resection for treating benign prostatic obstruction: a randomized trial with 2-year follow-up

OBJECTIVES

To investigate whether interstitial laser coagulation (ILC) is as effective and as safe as transurethral resection of the prostate (TURP). The treatment of choice for bladder outflow obstruction secondary to benign prostatic hyperplasia is TURP. However, ILC is a less invasive outpatient procedure that may be as effective and safe as TURP.

METHODS

In a multicenter randomized trial at six U.S. tertiary care hospitals, we treated 72 men with bladder outflow obstruction secondary to benign prostatic hyperplasia with either TURP (n = 35) or ILC (n = 37). The outcome measures were peak flow rate, postvoid residual urine volume, prostate volume, prostate-specific antigen levels, symptom and quality-of-life indexes, sexual function, and adverse event rates. Measurements were taken at baseline and at 3, 6, 12, and 24 months.

RESULTS

At 2 years, the TURP patients had better median peak flow rates, but not significantly so (range 16.5 to 13.9 mL/s, 95% confidence interval for the 2.6 mL/s difference of -0.4 to 7.6). The median scores on the symptom indexes and quality-of-life measures were similarly improved in both groups. Of 37 ILC patients, 6 (16%) were retreated with TURP in the first year. Sexual function declined in the TURP group but remained stable in the ILC group. The adverse event rates were similar, although the events were more serious in the TURP group.

CONCLUSIONS

ILC compares respectably with TURP. Given the advantages of an outpatient procedure, similar results in symptom reduction and quality-of-life measures, and less severe adverse effects, ILC can be an acceptable alternative to TURP.

Use and misuse of the concept of quality of life in evaluating surgical treatments for lower urinary tract symptoms

OBJECTIVE

To investigate how quality of life (QoL) components measured by given instruments direct the QoL perspective in treatment studies of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH).

METHODS

Computer searches were conducted in Medline, CINAHL and Psychinfo; MeSH terms covering QoL and surgical treatments for BPH and LUTS were combined for the search. The analysis was based on a framework linking components of QoL to patient outcome.

RESULTS

Of the 74 papers meeting the inclusion criteria, 48 were published in 1997-2001, showing the increase of interest of the topic. Most of the papers reported the change in QoL by a one-item scale, whilst only a few reported results from several of the components in the QoL concept. Some papers regarded the change in general health status or parts of health status as changes in QoL. Functional status and symptoms, and the bother of symptoms, were often regarded as indicators of a change in QoL.

CONCLUSION

These analyses show an increasing interest in measuring QoL after surgery for LUTS and BPH. In most of the studies analysed, the batteries of instruments selected were too narrow in scope to study the complexity of QoL. Most papers are based on instruments sensitive to change, but the reports do not distinguish the basic assumptions for understanding relationships important in QoL research and as a result, the reason for change is open to question.

Sexual function in patients treated for benign prostatic hyperplasia

CONTEXT

What is the effect of different treatment options for benign prostatic hyperplasia (BPH) on sexual function or dysfunction? With increasing age, sexual dysfunction and BPH become more prevalent. Some treatments for BPH can affect sexual function. Different surgical treatments have different effects on sexual function depending on how much the internal involuntary sphincter is affected. The same is true for medical therapies, each class of drug having a unique affect on sexual function.

STARTING POINT

In the past, many articles suggested a causal relation between BPH and sexual dysfunction. But a recent report by H Leliefeld and colleagues (BJU International 2002; 89: 208-13) confirms the idea that the relation is coincidental. Prospectively, these investigators examined patients at baseline and 9 months after various treatments for BPH with questionnaires on voiding symptoms, related complications, and sexual function. 84% of patients reported no change in sexual function. All treatments showed both improvement and deterioration in 3-14% and 0-16% of patients, respectively. As expected, age was the most important determinant of sexual function. In addition, the effect of severe irritative symptoms or the presence of urological comorbidity, such as bladder stones, increased the rate of sexual dysfunction. In this study, most patients underwent surgical therapy or watchful waiting while fewer had medical therapy. Too few patients had minimally invasive procedures to comment on their effect on sexual function. WHRE NEXT? Thus the relation between treatment of BPH (or watchful waiting) and sexual dysfunction is usually coincidental, unless symptoms become severe or complications (such as bladder stones or urinary retention) develop. More prospective studies are needed to assess the effect of BPH and its treatment on sexual function. Medical therapy is now more common than surgery in developed countries and treatment of BPH is commonly advocated for improvement in quality of life. Therefore any effects on sexual function become even more important. As minimally invasive surgical operations become more common, more data will be required for such interventions. The difficulty will be in keeping up with the rapidly evolving techniques of minimally invasive therapies.

Transurethral needle ablation of the prostate: an initial Japanese clinical trial

OBJECTIVES

Transurethral needle ablation of the prostate is a new alternative endoscopic thermal therapy that uses a low-energy radio frequency delivered into the prostatic adenoma. Herein is reported the initial clinical experience by multiple institutes in Japan of transurethral needle ablation of the prostate for the treatment of symptomatic benign prostatic hyperplasia.

METHODS

A total of 93 patients were treated with this technique. Transurethral needle ablation of the prostate was generally performed under low-spinal anesthesia. Before and after the procedure, international symptom score (IPSS), quality of life (QOL) score, peak urinary flow rate (Qmax), postvoid residual urine volume and prostate size were evaluated.

RESULTS

There was a reduction of IPSS of more than 50% when compared with that of pretreatment, being 51.3% (57/93 patients) and 60.2% (56/93 patients) at 3 months and 6 months after the procedure, respectively. Sixty-seven patients who were available for a 12-month follow-up period demonstrated a markedly decreased mean IPSS when compared with that measured before the treatment for a statistically significant difference (P < 0.01). Fifty-eight patients who were available for uroflowmetric study at 12 months exhibited a notably increased mean Qmax of 11.2 +/- 4.5 mL/s, which was a statistically significant increase when compared with that found before treatment (P < 0.05). Although all patients suffered some degree of gross hematuria after the procedure, none of them required any specific treatment for complications.

CONCLUSION

Transurethral needle ablation technique for the treatment of symptomatic benign prostatic hyperplasia is safe and effective. However, a much longer follow-up study is essential for fully evaluating the extended effectiveness of this technique.

Changing therapeutic regimens in benign prostatic hyperplasia. Clinical and economic considerations

About one-quarter of men aged 50 years and older experience voiding problems due to benign prostatic hyperplasia (BPH). Until about 10 years ago, surgery (particularly transurethral resection of the prostate) was the only effective treatment for symptomatic BPH. Over the last decade, several new treatments have been introduced. These include different types of medication (alpha-blockers and finasteride), thermotherapy, laser prostatectomy, needle ablation and vaporisation methods. The diffusion of these less invasive treatment modalities has resulted not only in a decrease in the age-adjusted surgery rates, but also in an increase of the total number of men treated for BPH. A large number of studies on clinical benefits and risks reveal that the conventional types of surgery remain the most effective treatments, whereas new interventional therapies require a shorter hospital stay and result in fewer short term complications. The efficacy of medication is lower than that of interventional treatments. Adverse effects include dizziness and orthostatic hypotension (alpha-blockers) and decreased sexual function (finasteride), but are generally mild. There is some evidence that medication and minimally invasive treatments may preclude eventual surgical treatment, but the precise effect is difficult to estimate because of differences in the study populations and the relatively short study periods. As a result of the dynamic nature of BPH treatment and the lack of long term data, the cost effects of the introduction of the various new treatments are also difficult to assess. Given the aging of the population and the growing percentage of patients with BPH for whom any type of treatment can be considered, a considerable increase of total costs can be expected. Long term prospective studies are necessary to gain insight into the most cost-effective treatment for different patient groups.

Transurethral needle ablation of the prostate: outcome at 1 year

BACKGROUND

Urologists continue to search for alternatives to transurethral prostatectomy that carry a lower potential for complications.

PATIENTS AND METHODS

Twenty-five patients on the public waiting list for transurethral resection of the prostate, all spontaneously voiding, underwent transurethral needle ablation of the prostate (TUNA). Eight patients had a simultaneous bladder neck incision (BNI). Follow-up with International Prostate Symptom Scores and flow rate measurement was performed at 6 weeks, 7 months, and 1 year.

RESULTS

A statistically significant increase in flow rate and fall in symptom scores occurred out to 1 year after TUNA. Despite this result, six patients (24%) were not satisfied with their outcome and underwent a second endoscopic operation.

CONCLUSION

In our hands, TUNA produced an unsatisfactory clinical result.