The Therapeutic Effect of TUNA for the Treatment of BPH Based on Pressure-flow Studies / 대한비뇨기과학회지

PURPOSE: We investigated the effects of transurethral needle ablation (TUNA) in men with benign prostatic hyperplasia (BPH) using a pressure-flow study. MATERIALS AND METHODS: A total of 25 patients with symptomatic BPH, and an obstructive pattern on urodynamics, were treated with TUNA. We evaluated the patients before TUNA treatment using the International Prostate Symptom Score (IPSS), quality of life scores (QOL), uroflowmetry, postvoid residual volume (PVR) and pressure-flow studies, for a mean of 6 months following treatment. RESULTS: At 6 months after TUNA, the IPSS decreased from a mean of 22.69 to 7.65 (p<0.01). The QOL scores improved from a mean of 4.65 to 2.13 (p<0.01). The peak flow rate and PVR improved from a mean of 8.13ml/sec to 13.79ml/sec and 98.52ml to 39.52ml (p<0.01), respectively. A reduction in the mean detrusor pressure at maximum flow rate (67.21cmH2O to 47.43cmH2O, p<0.01) and the Abrams-Griffiths number (51.39 to 20.65, p<0.01) indicated that TUNA can significantly lower bladder pressure. With the exception of one patient, no patient complained of any severe side effects. CONCLUSIONS: In patients with BPH, TUNA resulted significant clinical improvements, with no major complications, and slightly decreased the bladder outlet obstruction. We suggest that TUNA is a safe and effective method for treating bladder outlet obstructions due to BPH, especially, in patients at high risk of operative morbidity and mortality, and for aged patients afraid of sexual dysfunction and retrograde ejaculation.

The Therapeutic Effect of TUNA for the Treatment of BPH Based on Pressure-flow Studies / 대한비뇨기과학회지

PURPOSE: We investigated the effects of transurethral needle ablation (TUNA) in men with benign prostatic hyperplasia (BPH) using a pressure-flow study. MATERIALS AND METHODS: A total of 25 patients with symptomatic BPH, and an obstructive pattern on urodynamics, were treated with TUNA. We evaluated the patients before TUNA treatment using the International Prostate Symptom Score (IPSS), quality of life scores (QOL), uroflowmetry, postvoid residual volume (PVR) and pressure-flow studies, for a mean of 6 months following treatment. RESULTS: At 6 months after TUNA, the IPSS decreased from a mean of 22.69 to 7.65 (p<0.01). The QOL scores improved from a mean of 4.65 to 2.13 (p<0.01). The peak flow rate and PVR improved from a mean of 8.13ml/sec to 13.79ml/sec and 98.52ml to 39.52ml (p<0.01), respectively. A reduction in the mean detrusor pressure at maximum flow rate (67.21cmH2O to 47.43cmH2O, p<0.01) and the Abrams-Griffiths number (51.39 to 20.65, p<0.01) indicated that TUNA can significantly lower bladder pressure. With the exception of one patient, no patient complained of any severe side effects. CONCLUSIONS: In patients with BPH, TUNA resulted significant clinical improvements, with no major complications, and slightly decreased the bladder outlet obstruction. We suggest that TUNA is a safe and effective method for treating bladder outlet obstructions due to BPH, especially, in patients at high risk of operative morbidity and mortality, and for aged patients afraid of sexual dysfunction and retrograde ejaculation.

Early Experiences of the Transurethral Needle Ablation(TUNA) in BPH / 대한비뇨기과학회지

PURPOSE: TUNA is a new minimally invasive treatment modality for the patients with benign prostatic hyperplasia of prostate utilizing low levels of radiofrequency energy. We presented our early experiences of TUNA for the treatment of BPH to evaluate its clinical outcome. MATERIALS AND METHODS: From July 1995 to March 1997, 36 patients were treated with TUNA(15 with manual system, 21 with automatic system). Mean age of the patients was 63.5 years. All patients were evaluated preoperatively with PSA, AUA symptom score, uroflowmetry and transrectal ultrasonography(TRUS). AUA symptom score at 1, 3, 12 month and uroflowmetry at 1, 3 month postoperatively were available for analysis. RESULTS: Mean PSA value was 3.4ng/ml and mean prostate volume by TRUS was 35.5gram preoperatively. Nine out of 36 procedures were performed with local anesthesia. Mean operating time was 45.6 minutes. At postoperative 3 and 12 month, symptom score was improved from 22.0+/-1.5 to 11.7+/-1.6 and 11.0+/-1.9(p<0.05), respectively and maximal flow rate was increased from 11.2+/-0.7ml/sec to 14.4+/-1.5ml/sec at postoperative 3 month(p<0.05). Results have been far better since using automatic system. Complications were observed in one patient with clot retention and in 11 patients with postoperative urinary retention. CONCLUSIONS: TUNA is a simple, safe, efficacious and minimally invasive treatment procedure with short hospital stay, less morbidity for treatment of the patients with BPH. It could also be performed with local anesthesia. We suggest that TUNA would be a new promising treatment modality for BPH.

Transurethral Needle Ablation of BPH / 대한비뇨기과학회지

PURPOSE: Transurethral resection of prostate(TURP) is the gold standard for the treatment of benign prostate hyperplasia(BPH) at the present. But many attempts have been made to develop minimally invasive method. We studied the efficacy of transurethral needle ablation(TUNA) of prostate for treatment of BPH. MATERIALS AND METHODS: We performed TUNA in 20 BPH patients including 13 patients with acute urinary retention. Preoperatively all patients were evaluated using urinary flow rates, International Prostate Symptom Score(1-PSS), Quality of life and cystoscopic examination. The urinary flow rates, 1-PSS and Quality of life were checked at 1, 3 and 6 months after TUNA in all patients. RESULTS: The average value of peak flow rate of the patients with urinary retention were 10ml/sec, 12ml/sec and 13ml/sec at 1, 3 and 6 months follow-up. The average value of Qmax of the patients without urinary retention were 9ml/sec preoperatively and increased to 13ml/sec, 13ml/sec and 14ml/sec at 1, 3 and 6 months postoperatively. 1-PSS of patients with urinary retention improved from average 26 at preoperation to 14, 13, 10 at 1, 3 and 6 months postoperatively. Quality of life of patients with urinary retention improved from average 5 at preoperation to 2, 2, 2 at 1, 3 and 6 months postoperatively. The average value of patients without urinary retention improved from average 26, 5 at preoperation to 14, 11, 11 and 2, 2, 2 at 1, 3 and 6 months follow-up. No patients complained of erectile dysfunction and retrograde ejaculation postoperatively. CONCLUSIONS: The result of our preliminary study suggest that TUNA can be considered to be a simple, safe and efficacious procedure for the treatment of BPH including urinary retention.

Clinical Results Comparing Transurethral Needle Ablation with Transurethral Resection of Prostate for the Treatment of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: We compared the outcome of transurethral resection of the prostate (TURP) with that of transurethral needle ablation(TUNA) of the prostate in patient with BPH. MATERIALS AND METHODS: From May 1996 to April 1997, 21 patients were treated with TURP and 25 with TUNA. In TURP group, the mean age was 67.2 years and mean prostatic volume was 52.7ml. In TUNA group, the mean age was 67.2 years and mean prostatic volume was 32.1ml. Assessment parameters were International Prostate Symptom Score(1-PSS), quality of life question, uroflowmetry and complications. Post-treatment morbidity was noted if the patients experienced erectile dysfunction, retrograde ejaculation or urinary incontinence. Patients were examined at 3 months from the day of treatment. RESULTS: At 3 months, the maximum flow rate improved from the mean of 10.2+/- 3.2m1/sec to 20.5+/-10.7m1/sec for the TURP group and 9.3+/-1.9m1/sec to 12.5+/-4.3 for the TUNA group. 1-PSS improved from the mean 22.0+/-7.6 to 6.4+/-4.6 for the TURP group and 21.2+/-6.6 to 13.1+/-6.8 for the TUNA group. Quality of life improved from the mean 3.8)1.6 to 1.3+/-1.0 for the TURP group and 4.3+/-0.9 to 2.9+/-1.1 for the TUNA group. Erectile dysfunction was reported in 43% (9/21) of TURP and 5%(1/20) of TUNA. Retrograde ejaculation was reported in 57%(12/21) and urinary incontinence was in 5%(1/21) of TURP. Retrograde ejaculation and urinary incontinence was not reported with TUNA. The mean operation time, hospital stay and a catheterization time in the TUNA group were 45.4min, 1.2days, 4.4days in comparison with 58.7min, 7.0days, 3.6days in the TURP group. CONCLUSIONS: After TURP and TUNA, there was significant improvement in all clinical parameters. But TURP was more effective in improving maximum flow rate, 1-PSS and quality of life. TUNA, however, produced minimal morbidity with no serious complication. With acceptable low morbidity, TUNA appears to be a safe and effective procedure in the treatment of BPH.