The effect of transurethral needle ablation on symptoms of chronic pelvic pain syndrome - A pilot study

Objective: We evaluated the effects of transurethral needle ablation (TUNA) in chronic pelvic pain syndrome (CPPS). Material and methods: CPPS patients were subjected to TUNA (n = 21) or sham therapy (urethrocystoscopy) (n = 6). Digital rectal examination and transr ectal ultrasound were performed. Prostate-specific antigen and urine were a nalysed before and 1 month after treatment. Symptoms, the DAN-PSS-1 questio nnaire, urine flow, residual urine volume, medication and a subjective esti mation of the effect of treatment were evaluated during a follow-up period of 12 months. Results: In both groups the maximal urine flow increased and the DAN-PSS-1 score decreased, but the decrease in the DAN PSS-1 score was significant (p = 0.002) only in the TUNA group. The total symptom score decreased from 14 to 8.3 points in the TUNA group, and from 12.6 to 8.0 points in sham patie nts. TUNA relieved pain significantly. In the TUNA group symptoms were amel iorated in patients with small (less than or equal to 20 ml; p = 0.002) and large prostates (>20 ml; p = 0.04). Similarly, patients with both mild (p = 0.004) and severe (p = 0.02) symptoms at baseline benefitted from TUNA. O f the TUNA patients, 72% felt better at 1-year follow-up, although 57% stil l had symptoms and 38% needed medication. The figures in the sham group wer e 50%, 66% and 50%, respectively. Conclusions: TUNA relieved symptoms in CPPS patients for at least 12 months . The need for medication and the presence of symptoms were reduced, and th e fraction of patients satisfied with treatment was higher in the TUNA grou p than in the sham group. However, these differences between the groups wer e not statistically significant. To assess the clinical value of TUNA in CP PS a prospective double-blind study with a large number of patients is need ed to confirm the results of this pilot study.