A meta-analysis of trials of transurethral needle ablation for treating symptomatic benign prostatic hyperplasia.
OBJECTIVE
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.
Boyle
Peter
P
Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy. boyle@iarc.fr
Robertson
Christopher
C
Vaughan
E Darracott
ED
Fitzpatrick
John M
JM
D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000503:physiopathology / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D016055:Urinary Retention / Q000503:physiopathology; D014563:Urodynamics