Day-case local anaesthetic radiofrequency thermal ablation of benign prostatic hyperplasia - A four-year follow-up

Objective: This study reports long-term (median 4 years) clinical effective ness, safety and patient acceptance of transurethral ablation prostatectomy (TURAPY) fur symptomatic benign prostatic enlargement (BPE) using a radiof requency technique. Material and methods: 25 men were treated as day-case p rocedures under local anaesthesia for 1 h. The age range was 55-88 years (m ean age 65.5 years) and all were suffering from symptomatic BPE with urinar y flow rates of 12 ml/s or less. The treatment was carried out with a compu ter-based device using a special heating element mounted on a Foley-like ca theter for prostatic ablation and the temperatures were monitored continuou sly in the prostatic region, sphincteric area and rectum for safely purpose s. Results: TURAPY was carried out in all patients with temperatures rangin g from 70 to 82 degreesC depending on the tolerance of the patient. The pos t-treatment mortality was nil and only 19 patients complained of mild dysur ia, passing of some debris and/or minor bleeding on voiding which settled s pontaneously in 2-3 weeks, except in two patients who had proven urinary in fection requiring antibiotic therapy. At 4 years the International Prostate Symptom Score (I-PSS) improved from a mean value of 16.0 to 7.2 (p < 0.01) with quality-of-life score falling from 1 to 1.9 (p < 0.05), mean flow rar e increased from 8.5 to 11.7 ml/s and mean residual volume decreased from 1 85.04 to 52.8 mi (p < 0.05). post-treatment pressure flow studies in 14 pat ients showed normal pressure voiding in one, with four being in an equivoca l range, but the rest were obstructed. Prostate ultrasound scanning before and after. treatment in 15 patients showed a mean reduction of volume of 16 .7 mi suggesting cavitation of prostate following TURAPY. Conclusions: TURA PY provides lasting subjective but modest objective benefits in symptomatic BPE patients, It is worthy of consideration in elderly patients, or in tho se who are unfit fur surgery or who do not wish to undergo surgery. It is a safe procedure with little transient morbidity but no mortality.