The effect of transurethral needle ablation on symptoms of chronic pelvic pain syndrome--a pilot study.

OBJECTIVE: We evaluated the effects of transurethral needle ablation (TUNA) in chronic pelvic pain syndrome (CPPS). MATERIAL AND METHODS: CPPS patients were subjected to TUNA (n = 21) or sham therapy (urethrocystoscopy) (n = 6). Digital rectal examination and transrectal ultrasound were performed. Prostate-specific antigen and urine were analysed before and 1 month after treatment. Symptoms, the DAN-PSS-1 questionnaire, urine flow, residual urine volume, medication and a subjective estimation of the effect of treatment were evaluated during a follow-up period of 12 months. RESULTS: In both groups the maximal urine flow increased and the DAN-PSS-1 score decreased, but the decrease in the DAN-PSS-1 score was significant (p = 0.002) only in the TUNA group. The total symptom score decreased from 14 to 8.3 points in the TUNA group, and from 12.6 to 8.0 points in sham patients. TUNA relieved pain significantly. In the TUNA group symptoms were ameliorated in patients with small (< or = 20 ml; p = 0.002) and large prostates (> 20 ml; p = 0.04). Similarly, patients with both mild (p = 0.004) and severe (p = 0.02) symptoms at baseline benefitted from TUNA. Of the TUNA patients, 72% felt better at 1-year follow-up, although 57% still had symptoms and 38% needed medication. The figures in the sham group were 50%, 66% and 50%, respectively. CONCLUSIONS: TUNA relieved symptoms in CPPS patients for at least 12 months. The need for medication and the presence of symptoms were reduced, and the fraction of patients satisfied with treatment was higher in the TUNA group than in the sham group. However, these differences between the groups were not statistically significant. To assess the clinical value of TUNA in CPPS a prospective double-blind study with a large number of patients is needed to confirm the results of this pilot study.     

Randomized clinical trial comparing transurethral needle ablation with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: results at 18 months

PURPOSE: To compare the efficacy and safety of transurethral needle ablation (TUNA) and transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia (BPH) during an 18-months follow-up. PATIENTS AND METHODS: A series of 59 patients older than 40 years were included in this study. The entry criteria were prostate size <70 g, maximum urinary flow rate (Q(max)) <15 mL/sec, International Prostate Symptom Score (IPSS) >13, and no suspicion of prostate cancer according to the clinical or laboratory findings. Of the patients, 26 (44%) were treated with TUNA and 33 (56%) with TURP. At 3 and 18 months of follow-up, Q(max), postvoiding residual volume (PVR), IPSS, and the quality of life (QOL) score were compared with the baseline values. The results were also compared in patients undergoing TUNA v TURP. RESULTS: Improvements in Q(max), PVR, IPSS, and QOL score were statistically significant for both groups at 3 and 18 months of follow-up. The increase in the mean Q(max) of the TURP group was higher than that in the TUNA group, whereas no significant differences were found in the two groups regarding improvements in IPSS and QOL score. There were no complications associated with the TUNA procedure, while 16 retrograde ejaculation, 4 erectile impairment, 2 urethral stenosis, and 1 urinary incontinence cases were observed after TURP. CONCLUSIONS: The TUNA procedure is an effective and safe minimally invasive treatment with negligible adverse effect for selected patients with symptomatic BPH compared with TURP. It should be considered as an alternative treatment option for younger patients who want to preserve sexual function.     

Interstitial laser coagulation in patients with lower urinary tract symptoms from benign prostatic obstruction: treatment under sedoanalgesia with pressure-flow evaluation.

OBJECTIVES: To evaluate the effects on lower urinary tract symptoms and pressure-flow variables after interstitial laser coagulation (ILC) of the prostate using the Indigo diode laser system (Indigo, Palo Alto, USA). PATIENTS AND METHODS: Forty-nine men (median age 68 years, range 52-80) were assessed using symptom scores and voiding variables before and at 3 and 12 months after ILC. A subset of 26 men (median age 68 years, range 63-72) underwent pressure-flow measurements before and at 6 months after ILC. All treatments were performed in the outpatient department using sedoanalgesia. RESULTS: The International Prostate Symptom Score decreased from 22 to 11 at 12 months after ILC. The peak urinary flow (Qmax ) was 8.6 mL/s at baseline and increased to 9.9 mL/s at 12 months. Residual urine volumes were unchanged. The median duration of urinary retention after ILC was 3 days. From pressure-flow recordings, 17 patients were categorized as obstructed and seven as equivocally obstructed before ILC (using the International Continence Society definition). Their Qmax increased from 7.7 to 9.0 mL/s after 6 months, the detrusor pressure at Qmax decreased from 68 to 51 cmH2O and the Abrams-Griffiths number decreased from 54 to 29 (P<0.01). Patients with moderate to equivocal obstruction had a greater relief of symptoms than those who were clearly obstructed. Patients with prostate volumes of >40 mL had a greater decrease in the Abrams-Griffiths number than had patients with smaller prostates. Postoperative perineal pain was reported by 72% of patients; the pain subsided after 1-2 weeks. The re-treatment rate was 15% within the first year. CONCLUSION: Treatment with ILC produced substantial effects on symptoms and moderate to small changes in urodynamic variables. Patients with moderate or equivocal bladder outlet obstruction or large prostates seem to be the best candidates for this treatment. However, treatment was followed by perineal pain for 1-2 weeks in most cases. A long-term follow-up is necessary to determine the role of ILC.     

Transurethral needle ablation (TUNA) of the prostate: a clinical and urodynamic evaluation

Objectives. This prospective study evaluated the clinical and urodynamic changes in patients with obstruction due to benign prostatic hyperplasia (BPH) treated with transurethral needle ablation (TUNA)Methods. One hundred twenty patients with obstructive uropathy due to BPH were treated with the TUNA procedure between January 1994 and December 1995. All patients were selected according to the criteria established by the guidelines proposed by the International Consensus Committee (World Health Organization, Paris, 1993). The TUNA procedure was performed in an outpatient setting using topical intraurethral anesthesia (2% lidocaine gel).Results. Patients showed a decrease in irritative symptoms as measured by the International Prostate Symptom Score (IPSS) and postprocedure urodynamic parameters. The mean (± SD) pretreatment IPSS was 20.8 ± 4.5. At 3 months, the IPSS decreased to 9.7 ± 3.0 (108 patients) (P <0.001). At 6 months it decreased to 6.8 ± 3.1 (86 patients) and remained at 6.2 ± 2.9 (72 patients) and 6.7 ± 3.8 (42 patients) at 12 and 18 months, respectively (P <0.001). At 1 year after treatment, the peak flow rate (Qmax) increased from 8.2 ± 3.4 mL/s to 15.9 ± 2.1 mL/s and was 14.1 ± 2.5 mL/s at 18 months of follow-up (P <0.01). Urodynamic re-evaluation performed in 72 patients 12 months after TUNA demonstrated the absence of obstruction in 30 (41.7%). An additional 30 patients (41.7%) had equivocal results, whereas the remaining 12 (16.6%) still had obstruction, according to the Abrams-Griffith nomogram. Mean detrusor pressure at Qmax decreased from 85.3 ± 18.5 cm H₂O to 63.7 ± 24.9 cm H₂O at 12 months of follow-up.Conclusions. Our results confirm that the TUNA procedure is safe and effective when performed as an outpatient procedure. In addition, TUNA produced better results in patients presenting with moderate to severe irritative symptoms and minimal obstruction as determined by pressure/flow studies.     

A meta-analysis of trials of transurethral needle ablation for treating symptomatic benign prostatic hyperplasia

OBJECTIVES: To investigate the short- and long-term effectiveness of transurethral needle ablation (TUNA) of the prostate for clinical benign prostatic hyperplasia (BPH), using a meta-analysis of all clinical studies involving TUNA. METHODS: Data were extracted from two randomized trials, two non-randomized observational protocols and 10 single-arm studies conducted on TUNA, according to a determined protocol. The meta-analysis was based on the change in the mean score at the end of study from that at baseline. The estimation of the effects from the meta-analysis used a multilevel model including random effects for the studies. RESULTS: In all studies the patients recruited had severe lower urinary tract symptoms and a mean International Prostate Symptom Score (IPSS) of > 20 before treatment. The effect of TUNA was to halve the mean IPSS at 1 year after treatment and, although there was a slight tendency for the IPSS to increase in all arms from year 1 to year 5, this decrease by half was maintained at 5 years. The maximum urinary flow rate (Q(max)) also increased by approximately 70% from baseline to 1 year and in virtually all studies the mean Q(max) approached or exceeded 15 mL/s. Although there was a tendency for Q(max) to decline slightly over time, the mean Q(max) 5 years after treatment was > 50% over baseline. CONCLUSIONS: This meta-analysis shows that TUNA is an effective and minimally invasive treatment for men with clinical BPH, even when the symptoms are severe. There is a significant improvement in symptoms and flow rate after 1 year which persists for at least 5 years. TUNA therapy would appear to be an alternative to surgery and an attractive option for men who do not wish to undergo long-term medical therapy, are poor candidates for surgery or are concerned about the side-effects of TURP.     

How do I treat and follow my TUNA patients

Transurethral needle ablation (TUNA) of the prostate is an alternative treatment for benign prostatic hyperplasia (BPH) generating temperatures around 100°C leading to necrotic lesions inside the prostate. TUNA is a minimally invasive, low morbidity associated, approach that uses radiofrequency energy. The needles are covered by teflon shields that protect the urethra from thermal injury. Since the introduction of TUNA, there has been a constant upgrading of the device to improve treatment quality. The main advantage of this therapy is the possibility of an outpatient care due to its anaesthesia-free option with a prostatic block. Catheterisation after the procedure is required in 10–40% of cases. Long-term data (5 years) on TUNA demonstrate a sustained improvement of both IPSS score and urinary flow. About a quarter of patients require further intervention at 5 years’ follow-up. The safety profile, along with the significant improvement in both objective and subjective parameters observed after TUNA, makes it an attractive approach for symptomatic BPH.     

Efficacy of transurethral needle ablation of the prostate for the treatment of benign prostatic hyperplasia

BACKGROUND: We evaluated the efficacy and safety of transurethral needle ablation (TUNA) of the prostate for treatment of symptomatic benign prostatic hyperplasia (BPH) as one institute participating in a Japanese clinical trial. METHODS: Thirty-three patients with symptomatic BPH were treated with the TUNA procedure in our institute. The international prostate symptom score (IPSS), quality of life (QOL) score, residual urine volume (RV), prostate volume (PV) and peak urinary flow rates (Qmax) were measured and complications were assessed. RESULTS: We followed and evaluated 30 of the 33 cases. At 12 months there were significant improvements in the IPSS (20.7 to 11.2, P < 0.0001), QOL score (4.9 to 2.1, P < 0.0001), RV (46.6 to 22.6 mL, P < 0.01), PV (37.8 to 30.0 mL3, P < 0.002) and Qmax (8.00 to 11.0 mL/s, P < 0.002). There were no serious complications. CONCLUSION: This trial shows that the TUNA procedure is a safe and efficacious treatment for symptomatic BPH.     

Two-year results of transurethral resection of the prostate versus four 'less invasive' treatment options

OBJECTIVE: The aim of this study was to compare the efficacy or transurethral resection of the prostate (TURP) versus four less invasive treatment options during a 2-year follow-up. MATERIAL AND METHODS: 95 elderly men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) were assigned prospectively to the following five treatment arms; transurethral resection of the prostate (TURP; n = 28), transurethral electrovaporization (TUVP; n = 17), visual laser ablation of the prostate (VLAP; n = 17), transrectal high intensity focused ultrasound (HIFU; n = 20) and transurethral needle ablation (TUNA); n = 15). Preoperative workup included the International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual volume (PVR), prostate volume determined by transrectal ultrasonography and a multichannel pressure flow study. Postoperative follow-up at 6, 12, 18 and 24 months included assessment of IPSS, PVR and uroflowmetry. RESULTS: At study entry, patients assigned to one of the five treatment arms were comparable with respect to age, peak flow rate (Q(max)), IPSS, prostate size and the degree of bladder outflow obstruction. During study, 1 patient in the TURP group (4%) required a secondary TURP, as compared to 23.5% (n = 4) after TUVP, 26.7% (n = 4) after VLAP, 15% (n = 4) after HIFU and 20% (n = 3) following TUNA. In patients not subjected to a secondary procedure, the IPSS decreased a mean 13. 9 after TURP, as compared to 12.7 after TUVP, 12.9 after VLAP, 7.0 after HIFU, and 9.8 after TUNA. Q(max) increased 11.5 ml/s (mean) after TURP, as compared to 11.1 ml/s after TUVP, 5.6 ml/s after VLAP, 2.5 ml/s after HIFU and 2.3 ml/s after TUNA. CONCLUSION: In up to a quarter of the patients, a secondary TURP is performed within the first 2 years after 'less invasive' procedures. These data underline the need for long-term studies to reliably assess the role of less invasive procedures and to indicate that TURP is still competitive.     

Transurethral needle ablation for chronic nonbacterial prostatitis

OBJECTIVE: To investigate the efficacy of transurethral needle ablation (TUNA) of the prostate for treating chronic nonbacterial prostatitis unresponsive to conservative therapies. PATIENTS AND METHODS: Forty-two patients (mean age 38.5 years, range 25-52) with nonbacterial prostatitis in whom clinical management was unsuccessful in relieving the symptoms or signs of prostatitis were treated using TUNA. All patients had a high leukocyte count (> 15 per high-power field) in expressed prostatic secretions (EPS) with no bacterial growth in either urine or prostatic secretion cultures. Before TUNA all patients were evaluated using a symptom score, satisfaction score (quality of life) and an examination of prostatic secretions. All patients were reassessed using the same variables 1 and 3 months after TUNA. Of the 42 patients, 10 had their semen analysed before and 3 months after treatment. RESULTS: The mean (sd) symptom and satisfaction scores improved significantly, from 11.02 (2.90) to 5.00 (2.61) and from 4.84 (0.57) to 1.26 (1.18), respectively, 3 months after TUNA (both P < 0.05). Of the 42 patients, 30 (71%) had normal EPS results within 3 months of TUNA. Also, of 37 patients with high leukocyte counts (> 100 per high-power field) before TUNA, 26 (70%) had normal EPS results within 3 months afterward, and 29 (78%) had a satisfaction score of < 3 points. CONCLUSIONS: TUNA may be a possible treatment option for patients with chronic nonbacterial prostatitis that is unresponsive to conservative therapies. A long-term follow-up and randomized studies are needed to confirm the efficacy of the TUNA against intractable chronic prostatitis.     

A study of the efficacy and safety of transurethral needle ablation (TUNA®) treatment for benign prostatic hyperplasia

The objective of this early phase III study was to determine the efficacy and safety of transurethral needle ablation (TUNA®) in patients presenting in acute urinary retention due to benign prostatic hyperplasia (BPH). Between September 1993 and August 1994, 20 patients of mean age 68.8 years were entered into a two-center study and treated with TUNA® after presenting in acute urinary retention and having failed at least one trial of voiding. A mean of 5.4 lesions at shield temperatures of 54.6°C were produced. Patients were reviewed at 1, 3, 6, and 12 months (mean, 6.2 months). In 17 of 20 patients, voiding was reestablished in a mean of 2.6 days. Three patients required TURP for persistent retention, and 2 patients had delayed TURP for bothersome symptoms. Two voiders died later of unrelated causes. Five patients were lost to follow-up at 6 months but were voiding when last reviewed. Symptom scores decreased from a mean of 19.0 (range 4–35) to 8.25 (range 1–20) at 12 months (p = 0.06). Mean peak flow rate was 11.4 ml/sec (range 6.6–16.8) at 12 months (p = 0.001). Mean prostatic volume at baseline was 65.8 cc and decreased to 56 cc at 12 months (p = 0.111). The treatment was well tolerated by all patients, and side effects were mild, including urinary tract infection and epididymo-orchitis. This study demonstrates the safety and effectiveness of TUNA® procedure in patients with urinary retention due to benign prostatic hypertrophy. © 1996 Wiley-Liss, Inc.     

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.     

Durability and cost-effectiveness of transurethral needle ablation of the prostate as an alternative to transurethral resection of the prostate when alpha-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.     

A cost comparison of medical management and transurethral needle ablation for treatment of benign prostatic hyperplasia during a 5-year period

PURPOSE: We performed an analysis comparing the cost of medical management with TUNA therapy for a 5-year period. MATERIALS AND METHODS: Published costs for tamsulosin, finasteride, transurethral needle ablation (TUNA, Medtronic, Inc., Minneapolis, Minnesota) and transurethral resection of the prostate were used to construct a cost analysis model comparing medication with TUNA. The model analyzed monotherapy with an alpha-blocker (tamsulosin) and a 5alpha-reductase inhibitor (finasteride), combination therapy using both medications, and a mixed scenario using monotherapy and combination therapy. Published data were used to estimate the rate of surgical intervention in patients initially treated with medications or TUNA. RESULTS: Tamsulosin monotherapy was less expensive than TUNA for 5 years ($3,485 for tamsulosin vs $4,811 for TUNA year 5). Finasteride monotherapy reaches a break-even point with TUNA during year 5 ($4,867 for finasteride vs $4,811 for TUNA). Combination therapy reaches a break-even point with TUNA after approximately 2 years 7 months of treatment ($4,515 for combination therapy vs $4,572 for TUNA) and the mixed scenario breaks even with TUNA at approximately year 4 ($4,696 for medical management vs $4,645 for TUNA). CONCLUSIONS: The TUNA procedure compares favorably to combination medical therapy for the treatment of benign prostatic hyperplasia on a cost basis. alpha-Blocker monotherapy is less costly than TUNA while 5alpha-reductase inhibitor monotherapy is approximately equivalent to TUNA for 5 years. The TUNA procedure is less expensive than combination medical management for 5 years, with a break-even point at approximately 2 years 7 months.     

Office based transurethral needle ablation of the prostate with analgesia and local anesthesia

PURPOSE: We evaluated the efficacy and feasibility of performing office based transurethral needle ablation of the prostate with analgesia and local anesthesia. MATERIALS AND METHODS: A total of 56 consecutive patients underwent transurethral needle ablation of the prostate for symptomatic benign prostatic hyperplasia. Oral rofecoxib (50 mg) and ciprofloxacin (250 mg) were administered before the procedure with 25 mg hydroxyzine and 50 to 100 mg meperidine intramuscularly. A combination of 2% lidocaine solution and jelly was used for anesthesia. Patients rated discomfort during anesthesia administration and the procedure using a 10-point scale of 0--no discomfort to 10--the worst pain/discomfort ever experienced in the patient life. Overall satisfaction with the procedure was assessed with a 4-point scale of 1--very satisfactory to 4--very unsatisfactory. Followup was 12 months for uroflow and 36 months for International Prostate Symptom Score. RESULTS: The mean age of 47 patients was 65.4 years. Mean discomfort ratings were 3.6 and 4.9 for anesthesia administration and the procedure, respectively. Average operative time was 34.4 minutes, excluding anesthesia administration. The mean overall satisfaction score was 1.5. The mean preoperative International Prostate Symptom Score was 23.1, which improved to 10.9, 11.2, 12.3, 13.8 and 11.3 at 3, 6, 12, 24 and 36 months, respectively. Mean maximum uroflow improved from 8.2 ml/sec at baseline to 12.8, 13.9 and 13.3 ml/sec at 3, 6 and 12 months, respectively. CONCLUSIONS: Administration of an intramuscular narcotic combined with oral analgesic and topical lidocaine provided adequate pain control for transurethral needle ablation of the prostate, making it a feasible office procedure.     

Long-term results of microwave thermotherapy for symptomatic benign prostatic hyperplasia

PURPOSE: To study the long-term outcomes of men with moderately severe symptomatic benign prostatic hyperplasia (BPH) who were treated with transurethral microwave thermotherapy (TUMT) with the Dornier Urowave machine. PATIENTS AND METHODS: A total of 220 patients (mean age 66.2 years) with clinical BPH, an American Urological Association (AUA) Symptom Score of >or=13, and a peak urinary flow rate (Qmax) of 相似文献   

Bipolar transurethral resection of prostate in saline: preliminary report on clinical efficacy and safety at 1 year

PURPOSE: To determine the clinical efficacy and safety profile of the bipolar transurethral resection in saline (TURIS) system (Olympus Japan) in the treatment of men with benign prostate hyperplasia (BPH). PATIENTS AND METHODS: We prospectively evaluated 45 patients with a mean age of 66 years (range 50-87 years) who had clinically significant BPH and were treated with transurethral resection of prostate using the TURIS system beginning December 2003. Acute retention of urine was the indication in 49% of the patients. Patients had outpatient follow-ups at 1, 3, 6, and 12 months. RESULTS: A mean weight of 25.3 g of prostatic tissue was resected in a mean time of 42 minutes (range 15-75 minutes). The mean decrease in hemoglobin and sodium was 1.4 g/dL and 2.2 mmol/L, respectively. The mean follow-up period was 10 months. The mean International Prostate Symptom Score decreased from 22.6 preoperatively to 6.5 at 12 months and the mean Q(max) increased from 6.5 to 18.3 mL/sec at 12 months. Postoperative hemorrhage was seen in 6.6% of the patients, including 2 primary hemorrhages that necessitated blood transfusion (4.4%). Other complications were prolonged catheterization (11.1%), urinary-tract infection (8.9%), and bulbar urethral stricture (4.4%). CONCLUSIONS: This pilot study indicates that TURIS is a safe and efficacious treatment for BPH at 1 year.     

Radiofrequency ablation of primary and metastatic lung tumors: preliminary experience with a single center device

Background This study aimed to assess the feasibility and short-term results for percutaneous radiofrequency ablation in the treatment of primary and secondary lung tumors. Methods Between May 2003 and July 2004, 15 patients (mean age, 64.9 years; range, 51–80 years) with 18 pulmonary lesions (9 primitive non–small cell lung cancers and 9 metastases) underwent the ablation procedure. All the patients had absolute contraindications to the surgery. The procedure was performed under computed tomography (CT) guidance with anesthesiologic assistance using a coaxial Le Veen needle electrode. The results were evaluated by postprocedural CT scan, and then by clinical and laboratory examination and CT scan 1, 3, 6, 9, and 12 months after the treatment. Results A complete ablation was obtained for 16 of 18 lesions (88.9%), and a partial ablation was achieved for the remaining 2 lesions (central tumors). In terms of complications, there were five cases of pneumothorax (2 resolved spontaneously and 3 were drained through a coaxial needle), four middle pleural reactions, and one hemothorax that required draining surgically. Follow-up evaluation was performed for 16 of 18 lesions. Stability was observed in one of two central tumors that received partial ablation. The remaining 15 tumors that received a complete ablation were followed up for a mean of 5 months (range, 1–12 months). All 15 lesions appeared to be hypodense at the CT examination. Dimension reduction with progressive fibrotic scar formation was observed in seven of seven lesions during a follow-up period of 6 months or more. A recurrence at the site of the treatment for two of three lesions was observed during a 12-month follow-up period. One of these received a second radiofrequency ablation. Five patients experienced systemic disease progression. In four of these five patients, this progression was not associated with recurrence at the site of the treatment. Conclusion Radiofrequency ablation seems to be possible for “nonsurgical” patients with primary and secondary lung tumors. Good results in terms of local tumor control were observed during short-term follow-up evaluation.     

Pressure-flow studies in men with benign prostatic hypertrophy before and after treatment with transurethral needle ablation

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 H(2)O, with a baseline detrusor pressure at maximum flow of <60 cm H(2)O, with a pretreatment residual volume of <100 ml and with a QOL score of <5.     

Photoselective laser vaporization prostatectomy for acute urinary retention in China

PURPOSE: To assess the clinical efficacy and safety of photoselective laser vaporization of the prostate (PVP) in the treatment of patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Forty-two patients (mean age 72 +/- 5 years, range 65-89) with AUR because of BPH were treated with a prospective trial of PVP with the potassium-titanyl-phosphate (KTP) laser. The treatment outcome was evaluated with subjective and objective tests at 1, 3, 6, and 12 months after PVP using the International Prostate Symptom Score (IPSS), disease-specific quality of life (QoL) score, postvoid residual (PVR) urine volume, and maximum urinary flow rate (Qmax). The International Index of Erectile Function questionnaire and a self-designed ejaculatory questionnaire were completed at different follow-up times to determine patient satisfaction and changes in sexual function. RESULTS: After preliminary urine drainage and adequate preoperative preparation, PVP was performed and bladder outlet obstruction was effectively relieved. The mean prostate volume was 62.5 +/- 11.7 cc, and the mean residual volume with retention was 650 mL (range 240-1200 mL). Mean operative time was 28.6 +/- 5.7 minutes. Mean catheterization duration was 5.6 days (range 3-14 d). There was significant subjective improvement of symptoms and objective improvement in urinary flow rates at 12 months. The mean IPSS and QoL score decreased significantly (P < 0.05). Mean PVR volume also decreased. The mean Qmax was 16.2 +/- 4.6 mL/sec after treatment. Only two patients had recurrent urinary retention during follow-up. There were no intraoperative or postoperative adverse events. CONCLUSIONS: The early clinical results suggest that the PVP is a promising safe, effective, and less-invasive treatment with minimal morbidity for patients with urine retention secondary to BPH.