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
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
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DOI：
10.1016/s0302-2838(03)00218-5
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发表时间：
2003-07-01
期刊：
影响因子：
23.4
通讯作者：
Schulman, CC
中科院分区：
文献类型：
--
作者：
Zlotta, AR;Giannakopoulos, X;Schulman, CC
目的：经尿道前列腺电切术（TUNA）是治疗前列腺增生症（BPH）的一种安全有效的方法。然而，与BPH的所有替代疗法一样，主要的批评是缺乏长期数据。我们目前的临床结果TUNA治疗的患者，并遵循了5 years.Methods：188例连续的症状性前列腺增生与TUNA治疗，在三个不同的中心进行了为期五年的随访。所有患者均在局部麻醉下使用TUNA 11或TUNA III导管进行治疗，未进行全身麻醉或脊髓麻醉。基线和5年随访评估包括尿峰流量、国际前列腺症状评分（IPSS）和排尿后残余尿（PVR）。记录需要额外内科或外科治疗的患者人数。结果：平均随访63个月，平均尿峰流速从8.6 ml/s增加到12.1 ml/s（p < 0.01，t检验），IPSS和PVR分别从20.9和179 ml下降到8.7和122 ml（均p < 0.001，t检验）。峰值尿流率和IPSS改善至少50%的患者百分比分别为24%和78%。平均前列腺体积和PSA水平没有显著变化（5年时分别为53.9 cc vs. 53.8 cc和3.3 vs. 3.6 ng/ml，p值均> 0.05，t检验）。2例患者死于不相关的合并症，10例失访。12例患者（6.4%）接受了药物治疗，7例患者（3.7%）接受了第二次TUNA，22/186例（11.1%）接受了手术。总体而言，41/176例（188在开始，2例死亡和10个失访）或23.3%需要额外的治疗，在5年随访后，原来的TUNA procedure.Conclusions：TUNA是有效的，并提供了良好的长期临床改善，在5年随访。TUNA治疗在5年随访时经受住了时间的考验，失败率低且可接受。从长远来看，超过75%的患者不需要额外的BPH治疗。(C)2003 Elsevier Science B. V.保留所有权利。
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 11 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. (C) 2003 Elsevier Science B.V. All rights reserved.