Transurethral needle ablation of the prostate: clinical experience in patients in urinary acute retention.

OBJECTIVE: To evaluate the clinical outcome of patients in urinary retention due to benign prostatic enlargement (BPE) treated using transurethral needle ablation (TUNA), an outpatient procedure requiring only local intra-urethral anaesthesia and intravenous sedoanalgesia.

PATIENTS AND METHODS: The TUNA technique was used in 38 patients in acute retention due to BPE, 34 of whom were a poor surgical risk. A special cytoscopic catheter device delivered low-level radiofrequency (RF) energy interstitially to a localized area of the prostate, producing necrotic lesions within the prostatic parenchyma. After treatment, all men were evaluated using urinary flow rates, residual urine volume, the International Prostate Symptom Score and quality of life score at 1, 3 and 6 months.

RESULTS: The mean prostate size was 43.1 g (range 18-90). Tolerance of the procedure when using topical anaesthetic and intravenous sedation was excellent. Of the 38 patients treated using TUNA, 30 (79%) resumed voiding within a mean of 8.7 days (range 2-27). After 6 months, the sustained mean peak flow rate was 10.4 +/- 3.4 mL/s and the mean residual volume was 76 +/- 45 mL. Five of the patients who did not resume voiding after TUNA underwent retropubic prostatectomy and one patient underwent TURP. The mean prostate size in these patients was 55.7 g. Failure to void was associated with the treatment of too few areas of the prostate for its volume.

CONCLUSION: This study demonstrated that TUNA is highly effective in relieving patients in urinary retention due to BPE and seems particularly suitable for treating patients who are at greater risk during surgery.