The effects of transurethral needle ablation and resection of the prostateon pressure flow urodynamic parameters: Analysis of the United States randomized study
Cg. Roehrborn et al., The effects of transurethral needle ablation and resection of the prostateon pressure flow urodynamic parameters: Analysis of the United States randomized study, J UROL, 162(1), 1999, pp. 92-97
Purpose: We evaluated the effects of transurethral needle ablation and pros
tate resection on pressure flow urodynamic parameters in men with benign pr
ostatic hyperplasia (BPH), compared symptomatic and objective parameters of
efficacy 6 months after initial treatment, and determined whether urodynam
ic assessment may predict symptomatic improvement.
Materials and Methods: We enrolled 121 patients with clinical BPH, American
Urological Association symptom index of 13 or greater and maximum urinary
flow of 12 ml. per second or less in a randomized study comparing transuret
hral needle ablation to prostate resection at 7 institutions in the United
States. Patients underwent baseline and followup assessments at 6 months, i
ncluding pressure flow studies.
Results: Patients who underwent each procedure had statistically and clinic
ally significant improvement in symptom index, BPH impact index and quality
of life score. After needle ablation and prostate resection maximum flow i
mproved from 8.8 to 13.5 (p <0.0001) and 8.8 to 20.8 ml. per second (p <0.0
001), detrusor pressure at maximum flow decreased from 78.7 to 64.5 (p = 0.
036) and 75.8 to 54.9 cm. water (p <0.001), and the Abrams-Griffiths number
decreased from 61.2 to 37.2 (p <0.001) and 58.3 to 10.9 (p <0.001), respec
tively. At 6 months the differences in transurethral needle ablation and pr
ostate resection were significant in terms of maximum flow (p <0.001) and t
he Abrams-Griffiths number (p <0.001) but not detrusor pressure at maximum
flower symptom assessment tools. The presence or absence of urinary obstruc
tion at baseline did not predict the degree of symptomatic improvement in e
ither treatment group.
Conclusions: Transurethral needle ablation and prostate resection induce st
atistically and clinically significant improvement in various quantitative
symptom assessment questionnaires at 6 months. The parameters of free flow
rates and invasive pressure flow studies also significantly improve after e
ach treatment. However, transurethral prostate resection induces a signific
antly greater decrease in the parameters of obstruction. Baseline urodynami
c parameters do not predict the degree of symptomatic improvement and they
may not be helpful in patient selection for transurethral needle ablation.