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1999 Selected Abstracts from American Urological Association annual meeting

3 Year Prospective Follow-Up Of 91 Men Treated With Transurethral Needle Ablation Of Prostate (Tuna™)

Siva Namasivayam, Ian Eardley, Leeds, England. Nicolas P Bryan, Ken J Hastie, Christopher R Chapple, Sheffield, UK (Presented by Mr. Bryan).
Introduction and Objectives: Reports of the early outcome of TUNA show many men to have symptomatic improvement but on post-operative pressure/flow urodynamics they are still obstructed. We have followed patients up for 3 years to determine the outcome after TUNA.
Methods: 91 men (mean age 68.7, range 54-83.9) were treated with TUNA for bladder outflow obstruction(BOO) secondary to BPH. They were assessed pre-and 3-6 months post-operatively with IPSS, free-flow rate and pressure/flow urodynamics. End-points were; death or requiring further prostate surgery. At 3 years, those who had not reached an end-point were invited back for review. 39 men who had further prostate surgery were asked to complete the IPSS at 3 years after TUNA.
Results: Those who had further surgery had a significantly higher IPSS at baseline (24.4 vs 20.3, p=0.002) but there was no significant difference in flow rate (8.2 vs 9.4 respectively, p=0.08). After TURP the mean IPSS decreased from 11.9 to 8.8(p=0.2). In the group who have not required further prostatic surgery after TUNA, at 3 years, there was a significant improvement in the mean IPSS (21.9 to 10.5, p<0.001) and a small but significant improvement in free/flow rate (8.8mL/s to 11.9mL/s, p<0.001). Urodynamics showed patients are still obstructed after TUNA. Following men up to 3 years after TUNA; 39 men had had further prostate surgery, 3 are on a waiting list for TURP, 2 are unfit to have surgery, 2 men have died.
Conclusions: Despite the apparent advantages of TUNA as a minimally invasive technique which can be performed under local anaesthetic, in our experience 48.4% of men who have had TUNA will require further prostatic surgery within 3 years. This emphasizes the importance of not only short term efficacy but also long term outcome which has important implications for cost efficacy.
Source of Funding: None
Source: 1999 AUA Meeting

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