Pressure-flow studies in men with benign prostatic hypertrophy before and after treatment with transurethral needle ablation

Background/Aims: In this study we wanted to examine the effects that transu rethral needle ablation (TUNA) might have on the urodynamic characteristics of bladder outlet obstruction and to evaluate the clinical changes and the safety profile in patients undergoing the TUNA procedure, including the ef fects on erectile and ejaculatory function. Materials and Methods: We evalu ated 24 patients, aged between 66 and 81 (mean 73.4) years with a mean pros tatic volume of 57 +/- 15 mi. Before treatment, the clinical history was co llected, then prostate-specific antigen (PSA) analysis, digital rectal exam inations, I-PSS and quality-of-life (QOL) tests, uroflowmetry with residual volume, and pressure-flow studies were performed in all patients. After tr eatment, all the patients were evaluated at 6, 12 and 24 months by the same parameters. Results: After treatment, the I-PSS and QOL scores were consid erably improved, and the mean flow rate and the residual volume were also i mproved. The serum PSA level remained unchanged. The prostatic volume was a lmost unchanged, and pressure-flow studies showed a reduction in the mean o pening pressure and detrusor pressure at maximum flow after treatment. None of the patients complained of alterations in sexual activity nor retrograd e ejaculation. Conclusions: Our study confirms that in patients with benign prostatic hyperplasia, the TUNA procedure results in no major complication s and in significant clinical improvements. There was an improvement in the subjective and objective variables, such as symptom scores and frequency v olume charts and, in the majority of patients, subjective and objective imp rovements were sustained for the duration of this study, which included a 2 -year follow-up with pressure-flow studies. From our experience we can say that the ideal candidate for TUNA treatment should be younger than 70 years , with a prostatic volume of <60 cm H2O, with a baseline detrusor pressure at maximum flow of <60 cm H2O, with a pretreatment residual volume of <100 mi and with a QOL score of <5. Copyright (C) 2001 S. Karger AG, Basel.