eMedicine Specialties > Urology > Benign Prostatic Hypertrophy

Transurethral Needle Ablation of the Prostate (TUNA): Follow-up

Author: Nicolas A Muruve, MD, FRCSC, FACS, Associate Staff, Department of Urology, Cleveland Clinic Florida
Coauthor(s): Keith Steinbecker, MD, Consulting Staff, Department of Urology, St John's Mercy Medical Center; T Brian Willard, MD, Consulting Staff, Department of Surgery, Division of Urology, Lexington Urological Associates
Contributor Information and Disclosures

Updated: Feb 7, 2008

Outcome and Prognosis

Numerous clinical trials have been performed worldwide. Various parameters are used to assess the performance of transurethral needle ablation (TUNA). Subjective improvement ranges from 56-61% at 6 months, 40-70% at 1 year, and 57-73% at 2 years. In a review of more than 10 studies on 546 patients, the overall average improvement was 58% at 1 year, 60% at 2 years, and 66% at 3 years.

Schulman and Zlotta collected data for 2 years from 150 men with symptomatic benign prostatic hypertrophy (BPH).9 They found the following: (1) the peak flow rate (PFR) improved from 9.8 mL/s to 17 mL/s at 1 year and to 16.8 mL/s at 2 years, (2) the mean AUA Symptom Score improved from 21 to 8.8 at 1 year and to 9.2 at 2 years, and (3) the mean postvoid residual urine volume improved from 77 mL to 44 mL at 1 year and to 25 mL at 2 years.

PFRs (Q-max) improved from 28% to 93%. After TURP, the Q-max typically increased more than 100%. In a review of 546 patients, the average improvement was 77% at 1 year, 82% at 2 years, and 92% at 3 years.

Hill et al recently studied the durability of TUNA 5 years after treatment.10 They found that patients treated with TUNA had stable responses over 5 years based on IPSS, quality of life, and PFR. These were all statistically significant at all yearly intervals when compared to baseline. At 5 years, IPSS scores decreased from 24 to 10.7, quality of life improved from 11.8 to 3.8, and PFR improved from 8.8 mL/s to 11.4 mL/s.

In the prospective American study, TURP was randomized against TUNA (see Table 2). In the TURP group, PFRs at 12 months were 20.8 mL/s. In the TUNA group, PFRs were 15 mL/s. Both groups had initial PFRs of 8.8 mL/s. The AUA Symptom Scores improved from 23.9 to 11.1 in the TUNA arm and from 24.1 to 8.3 in the TURP arm.

The decrease in the postvoid residual urine volume after a TUNA procedure is 13-80%. Acceptable evidence does not exist that demonstrates a significant reduction in prostate size. No long-term data beyond 3 years are available.

Few studies exist regarding the efficacy of the TUNA procedure on the treatment of urinary retention secondary to BPH. Zlotta et al reported a success rate of 79% (30 of 38) in patients with retention.8 In addition, Millard et al reported a success rate of 78% (15 of 20) in treating patients with retention.7

Although the ideal use of TUNA has been thought to be in patients with large lateral lobes, Naslund and Stitcher reported that TUNA can be used effectively in patients with large median lobes.1 The key to this form of treatment is to ensure that the needles are in the median lobe and do not protrude into the bladder.

Very limited experience has been gained with TUNA being used to treat patients with high bladder necks. At this time, these patients should probably be treated with another form of therapy.

Table 2. Comparison of TURP and TUNA 

Open table in new window

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Table
TURPTUNA
Initial peak flow8.8 mL/s8.8 mL/s
Peak flow at 12 mo20.8 mL/s15 mL/s
Improvement in AUA Symptom
Score		From 23.9 to 11.1From 24.1 to 8.3
TURPTUNA
Initial peak flow8.8 mL/s8.8 mL/s
Peak flow at 12 mo20.8 mL/s15 mL/s
Improvement in AUA Symptom
Score		From 23.9 to 11.1From 24.1 to 8.3

Future and Controversies

Expect further advances and refinement of the existing technologies. A further study is needed in order to maximize the usefulness of transurethral needle ablation (TUNA). Without question, TUNA offers the patient a less morbid procedure. The results of TUNA are undeniably promising, yet by no means are they as good as TURP (ie, the criterion standard). The greatest difficulty in evaluating TUNA is determining the durability of its results. Certainly, only time will tell.

At present, the decision to proceed with surgical treatment of benign prostatic hypertrophy (BPH) is difficult. Obviously, the decision is based on the patient's and the surgeon's preferences but comes down to the fact that TUNA is better tolerated, carries fewer adverse effects, and generally offers reasonable results compared with those of TURP. In the authors' opinion, if the patient and the physician are in agreement, these reasons are worth the uncertainty of the long-term results and the possibility of a poorer outcome.

 


More on Transurethral Needle Ablation of the Prostate (TUNA)

Overview: Transurethral Needle Ablation of the Prostate (TUNA)
Workup: Transurethral Needle Ablation of the Prostate (TUNA)
Treatment: Transurethral Needle Ablation of the Prostate (TUNA)
Follow-up: Transurethral Needle Ablation of the Prostate (TUNA)
References
Further Reading
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References

  1. Naslund MJ, Stitcher MF. A cost comparison of TUNA vs TURP. J Urol. 1997;157 (supplement):155A.

  2. Chapple CR, Issa MM, Woo H. Transurethral needle ablation (TUNA). A critical review of radiofrequency thermal therapy in the management of benign prostatic hyperplasia. Eur Urol. Feb 1999;35(2):119-28. [Medline].

  3. Naslund MJ, Carlson AM, Williams MJ. A cost comparison of medical management and transurethral needle ablation for treatment of benign prostatic hyperplasia during a 5-year period. J Urol. Jun 2005;173(6):2090-3; discussion 2093. [Medline].

  4. Rosario DJ, Woo H, Potts KL, Cutinha PE, Hastie KJ, Chapple CR. Safety and efficacy of transurethral needle ablation of the prostate for symptomatic outlet obstruction. Br J Urol. Oct 1997;80(4):579-86. [Medline].

  5. Kahn SA, Alphonse P, Tewari A, Narayan P. An open study on the efficacy and safety of transurethral needle ablation of the prostate in treating symptomatic benign prostatic hyperplasia: the University of Florida experience. J Urol. Nov 1998;160(5):1695-700. [Medline].

  6. Rodrígo Aliaga M, López Alcina E, Monserrat Monfort JJ, Pontones Moreno JL, Valls Blasco F, Boronat Tormo F, et al. [Treatment of benign hyperplasia of the prostate using thermal transurethral needle ablation (TUNA)]. Actas Urol Esp. Jul-Aug 1997;21(7):649-54. [Medline].

  7. Millard RJ, Harewood LM, Tamaddon K. A study of the efficacy and safety of transurethral needle ablation (TUNA) treatment for benign prostatic hyperplasia. Neurourol Urodyn. 1996;15(6):619-28; discussion 628-9. [Medline].

  8. Zlotta AR, Peny MO, Matos C, Schulman CC. Transurethral needle ablation of the prostate: clinical experience in patients in urinary acute retention. Br J Urol. Mar 1996;77(3):391-7. [Medline].

  9. Schulman CC, Zlotta AR. Transurethral needle ablation of the prostate for treatment of benign prostatic hyperplasia: early clinical experience. Urology. Jan 1995;45(1):28-33. [Medline].

  10. Hill B, Belville W, Bruskewitz R, Issa M, Perez-Marrero R, Roehrborn C, et al. Transurethral needle ablation versus transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia: 5-year results of a prospective, randomized, multicenter clinical trial. J Urol. Jun 2004;171(6 Pt 1):2336-40. [Medline].

  11. Beduschi MC, Oesterling JE. Transurethral needle ablation of the prostate: a minimally invasive treatment for symptomatic benign prostatic hyperplasia. Mayo Clin Proc. Jul 1998;73(7):696-701. [Medline].

  12. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. Sep 1984;132(3):474-9. [Medline].

  13. Bouza C, Lopez T, Magro A, Navalpotro L, Amate JM. Systematic review and meta-analysis of Transurethral Needle Ablation in symptomatic Benign Prostatic Hyperplasia. BMC Urol. 2006;6:14. [Medline].

  14. Boyle P, Robertson C, Vaughan ED, Fitzpatrick JM. A meta-analysis of trials of transurethral needle ablation for treating symptomatic benign prostatic hyperplasia. BJU Int. Jul 2004;94(1):83-8. [Medline].

  15. Bruskewitz R, Issa MM, Roehrborn CG, Naslund MJ, Perez-Marrero R, Shumaker BP, et al. A prospective, randomized 1-year clinical trial comparing transurethral needle ablation to transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia. J Urol. May 1998;159(5):1588-93; discussion 1593-4. [Medline].

  16. Guess HA, Arrighi HM, Metter EJ, Fozard JL. Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate. 1990;17(3):241-6. [Medline].

  17. Lepor H. Natural History, Evaluation, and Nonsurgical Management of Benign Prostatic Hyperplasia. In: Walsh PC,Retik AB, Vaughan ED Jr, Wein AJ. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:1453-60.

  18. McConnell JD. Epidemiology, Etiology, Pathophysiology, and Diagnosis of Benign Prostatic Hyperplasia. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:1429-52.

  19. McCullogh DL. Minimally Invasive Treatment of Benign Prostatic Hyperplasia. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:1503-5.

  20. Mebust WK. Transurethral Surgery. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:1511-28.

  21. Perlmutter AP. New Uses of Energy for the Treatment of BPH. AUA Update Series. 1997;XVI:250-5.

  22. Roehrborn CG, Issa MM, Bruskewitz RC, Naslund MJ, Oesterling JE, Perez-Marrero R, et al. Transurethral needle ablation for benign prostatic hyperplasia: 12-month results of a prospective, multicenter U.S. study. Urology. Mar 1998;51(3):415-21. [Medline].

  23. Schulman CC, Zlotta AR. Transurethral needle ablation (TUNA) of the prostate: clinical experience with two years follow-up in patients with benign prostatic hyperplasia (BPH). Eur Urol. 1996;30(Suppl 2):263.

  24. Schulman CC, Zlotta AR, Rasor JS, Hourriez L, Noel JC, Edwards SD. Transurethral needle ablation (TUNA): safety, feasibility, and tolerance of a new office procedure for treatment of benign prostatic hyperplasia. Eur Urol. 1993;24(3):415-23. [Medline].

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Further Reading

For additional information, visit Medscape’s BPH Resource Center.

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Keywords

transurethral needle ablation, transurethral needle ablation of the prostate, TUNA, transurethral destruction of prostate tissue by radiofrequency thermotherapy, TUMP, prostate cancer, prostate surgery, prostate-specific antigen, prostate specific antigen, PSA, prostate needle ablation, benign prostatic hypertrophy, benign prostatic hyperplasia, BPH, prostatism, American Urologic Association Symptom Score, AUA Symptom Score, International Prostate Symptom Score, IPSS, prostatic enlargement, enlarged prostate, digital rectal examination, DRE, interstitial radiofrequency needles, interstitial RF needles, heat-induced coagulation necrosis, transurethral resection of the prostate, TURP, TUNA of the prostate, diminished uroflow, urodynamic obstruction

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Contributor Information and Disclosures

Author

Nicolas A Muruve, MD, FRCSC, FACS, Associate Staff, Department of Urology, Cleveland Clinic Florida
Nicolas A Muruve, MD, FRCSC, FACS is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, American Urological Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Keith Steinbecker, MD, Consulting Staff, Department of Urology, St John's Mercy Medical Center
Keith Steinbecker, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

T Brian Willard, MD, Consulting Staff, Department of Surgery, Division of Urology, Lexington Urological Associates
T Brian Willard, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Allen Donald Seftel, MD, Professor, Department of Urology, Case School of Medicine
Allen Donald Seftel, MD is a member of the following medical societies: Ohio State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Stephen W Leslie, MD, FACS, Founder and Medical Director of the Lorain Kidney Stone Research Center, Clinical Assistant Professor, Department of Urology, Medical College of Ohio
Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, National Kidney Foundation, and Ohio State Medical Association
Disclosure: Nothing to disclose.

 
 
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