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).


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.
Aaltomaa
S
S
Department of Urology, Kuopio University Hospital, Finland. sirpa.aaltomaa@kuh.fi
Ala-Opas
M
M
D000368:Aged; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods; D002908:Chronic Disease; D003558:Cystoscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009339:Needles; D017699:Pelvic Pain / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery; D013577:Syndrome; D014521:Urethra; D014524:Urethral Obstruction / Q000150:complications / Q000601:surgery