Abstract
Benign prostatic hyperplasia (BPH) is a nonmalignant growth of the prostate gland that can lead to a constellation of symptoms in the aging male known as lower urinary tract symptoms (LUTS). Over the last decade, several minimally invasive therapies have been developed for the treatment of benign prostatic hyperplasia in men who are unwilling to remain on medication, in whom medical therapy has failed, who are unsuitable candidates for surgery, and in men who are concerned about the side effects of TURP. One minimally invasive therapy, TUNA, uses low-level radiofrequency energy to heat prostatic tissue and create a controlled localized necrotic lesion. The tissue is then selectively ablated with temperatures exceeding 60 °C while preserving the prostatic urothelium. One of the major advantages to transurethral needle ablation of the prostate (TUNA) is it can be performed in the office under topical anesthesia. With recent advances in technology, TUNA can now be used to create extremely precise microscopic and macroscopic lesions within the prostate. In the short term, the majority of patients have subjective (symptomatic) and objective (Qmax) improvements, even when presenting symptoms are severe.
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Abbreviations
- BPH:
-
Benign prostatic hyperplasia
- I-PSS:
-
International prostate symptom score
- LUTS:
-
Lower urinary tract symptoms
- MTOPS:
-
Medical therapy of prostate symptoms
- Pdet:
-
Detrusor pressure
- PFR:
-
Peak flow rate
- PVR:
-
Post void residual
- Qmax:
-
Max flow rate
- QOL:
-
Quality of life
- RF:
-
Radiofrequency energy
- TRUS:
-
Transrectal ultrasound
- TUMT:
-
Transurethral microwave thermotherapy
- TUNA:
-
Transurethral needle ablation of the prostate
- TURP:
-
Transurethral resection of prostate
References
Chute GG, Panser LA, Girman CJ, Oesterling JE, Guess HA, Jacobsen SJ, et al. The prevalence of prostatism: a population-based survey of urinary symptoms. J Urol. 1993;150:85.
McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Dixon CM, Kusek JW, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003;349:2387.
Calkins H, Sousa J, El-Atassi R. Diagnosis and cure of the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardias during a single electrophysiologic test. N Engl J Med. 1991;324:1612.
Goldwasser B, Ramon J, Engelberg S. Transurethral needle ablation (TUNA) of the prostate using low-level radiofrequency energy: an animal experimental study. Eur Urol. 1993;24(3):400–5.
Schulman CC. Vandenbossche (TURF) Transurethral radiofrequency heating for benign prostatic hyperplasia at various temperatures with Thermex II: clinical experience. Eur Urol. 1993;23(2):302–6.
Schulman C, Zlotta A. Transurethral needle ablation of the prostate (TUNA): pathological, radiological and clinical study of a new office procedure for treatment of benign prostatic hyperplasia using low-level radiofrequency energy. Arch Esp Urol. 1994;47(9):895–901.
Zlotta AR, Raviv G, Peny MO, Noel J, Schulman C. Possible mechanisms of action of transurethral needle ablation of the prostate on benign prostatic hyperplasia symptoms: a neuro histochemical study. J Urol. 1997;157:894.
Hill B, Belville W, Bruskewitz R, Naslund M. 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. J Urol. 2004;171:2336–40.
Zlotta AR, Giannakopoulos X, Maehlum O, Ostrem T, Schulman C. 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. Eur Urol. 2003;44(1):89–93.
Boyle P, Robertson C, Vaughan ED, Fitzpatrick JM. A meta-analysis of trials of transurethral needle ablation for treating symptomatic benign prostatic hyperplasia. BJU Int. 2004;94(1):83–8.
American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH) 2010
Campo B, Bergamaschi F, Corrada P, Ordesi G. Transurethral needle ablation (TUNA) of the prostate: a clinical and urodynamic evaluation. Urology. 1997;49(6):847–50.
Steele GS, Sleep DJ. Transurethral needle ablation of the prostate: a urodynamic based study with 2-year follow-up. J Urol. 1997;158:1834–8.
Vaughan ED. Medical management of benign prostatic hyperplasia—are two drugs better than one? N Engl J Med. 2003;349:2449.
Naslund M, Carlson AM, Williams MJ. A cost comparison of medical management and transurethral needle ablation for treatment of benign prostatic hyperplasia during a 5-year period. J Urol. 2005;173:2090–3.
Schulman CC, Zlotta AR. Transurethral needle ablation of the prostate for treatment of benign prostatic hyperplasia: early clinical experience. Urology. 1995;45(1):28–33.
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Marley, C.S., Rutman, M.P. (2015). Transurethral Needle Ablation. In: Chughtai, B., Te, A., Kaplan, S. (eds) Treatment of Benign Prostatic Hyperplasia: Modern Alternative to Transurethral Resection of the Prostate. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1587-3_17
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DOI: https://doi.org/10.1007/978-1-4939-1587-3_17
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