TRANSURETHRAL NEEDLE ABLATION OF THE PROSTRATE - A URODYNAMIC BASED STUDY WITH 2-YEAR FOLLOW-UP

Purpose: We evaluated the efficacy of transurethral needle ablation of the prostate for the treatment of lower urinary tract symptoms relate d to benign prostatic hyperplasia (BPH). This study was urodynamic bas ed with 2-year followup to determine whether transurethral needle abla tion df the prostate could reduce bladder outlet obstruction and, if s o, whether the effect was durable. Materials and Methods: A total of 4 7 patients with symptomatic BPH underwent transurethral needle ablatio n of the prostate under local anesthesia and intravenous sedation. All patients were evaluated subjectively using the American Urological As sociation symptom index and the quality of life score. Patients were e valuated objectively with uroflowmetry, post-void residual volume and pressure-flow studies. All patients underwent subjective and objective evaluation before treatment. Followup was conducted at 1, 3, 6, 12 an d 24 months after treatment. Short and long-term complications were as sessed. Results: At 6-month followup there was 71% improvement in mean cases (22.4 to 6.6, 42 patients symptom index, p <0.05), and 66% impr ovement in mean quality of life score (4.6 to 1.56, 42 patients, p <0. 05). Maximum flow rate, post-void residual volume and detrusor pressur e at maximum flow rate also showed statistically significant improveme nts throughout the study. At 12-month followup there was a 55% increas e in maximum flow rate (6.6 to 10.23 mi. per second, 29 patients, p <0 .05). A 37% reduction in mean detrusor pressure at maximum flow rate ( 92.4 cm. to 58 cm. water, 31 patients, p <0.05) was recorded at 24-mon th followup, thus indicating that transurethral needle ablation of the prostate can lower bladder pressure-significantly. Postvoid residual volume decreased from a pretreatment mean of 76.1 mi. to a mean of 36. 9 mi. (31 patients, p <0.05) at 24 months. Short-term complications (3 months) included transient posttreatment urinary retention in 8 patie nts (17%), duration I to 9 days, mild to moderate transient frequency dysuria all patients which resolved in more than 90% by 5 weeks and ep ididymitis in 1. A patient questionnaire was used to evaluate changes in sexual function and there were no reports of disturbances in erecti le function or retrograde ejaculation. There were no long-term complic ations. However, 6 patients (12.7%) had persistent bothersome symptoms during the followup period and underwent transurethral prostate resec tion. Further analysis of this subset of patients with respect to pret reatment evaluation and transurethral needle ablation procedure did no t reveal significant differences between them and patients with succes sful outcomes. Conclusions: Transurethral prostate resection is a safe and effective technique for treating lower urinary tract symptoms rel ated to benign prostatic hyperplasia, The technique can be performed i n the office as an outpatient, or as a same day surgical procedure, us ing topical anesthesia with intravenous sedation, if necessary. In the majority of patients subjective and objective improvements were susta ined for the duration of this study, which included a-year followup wi th pressure-flow studies.