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Transurethral needle ablation (tuna™) of the prostate: Clinical experience with three years follow-up in patients with benign prostatic hyperplasia (BPH)

par Schulman, Claude ;Zlotta, Alexandre
Référence British journal of urology, 80, SUPPL. 2, page (201)
Publication Publié, 1997

Article révisé par les pairs

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Résumé :

We studied the clinical efficacy of TUNA of the prostate for treatment of symptomatic BPH with a long-term follow-up. TUNA is a minimally invasive outpatient anesthesia-free procedure. TUNA selectively creates prostatic tissue necrosis by delivering low-level radiofrequency energy at temperatures around 100°C. After having previously described the pathological effects of TUNA and early clinical results, we report our clinical experience with TUNA for BPH with a 3 year follow-up. 48 patients with symptomatic BPH treated with TUNA were clinically evaluated in the present study for follow-up. Pre-treatment inclusion criteria included peak flow rates (<15 ml/s), prostate volume (<90cc), residual volume (<200 ml). International Prostate Symptom Score (IPSS>18) and quality of life(>3). TUNA was performed in all patients under local anesthesia. Peak flow rate increased from a mean of 9.9 ml/s (5.5-14.6) to 16.8 ml/s (9-24.5) at I year follow-up (n=34) (p<0.01), 16.4 ml/s (9.8-25.0) at 2 year follow-up (n=24) and 16.9 ml/s at 3 year follow-up (n=14) (p<0.01). IPSS improvpd from a mean 21.6 (16-30) to 9.0 (1-18) at 1 year follow-up (p<0.001) and 8.5 (1-15) at both 2 and 3 year follow-up (p<0.001). Residual volume decreased from 85 ml at baseline to 42, 47 and 40 ml at 1, 2 and 3 years respectively (p<0.01). No significant complications were encountered. Transient retention (2-5 days) was observed in 39% of cases. No retrograde ejaculation or impotence was noticed. 70% of the patients were objectively improved by TUNA and this improvement was sustained in 75% of them at three years follow-up. Eight patients (16.6%) have been operated for absence of clinical improvement and 5 patients have died of intercurrent disease (10.4%). Failures were associated with a median lobe or further increase of prostate volume. Our study confirms with a 3 year follow-up the initial encouraging clinical results of TUNA and its effectiveness as an minimally invasive anesthesia-free alternative treatment for BPH.