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Resume But Evaluer l’efficacite et la morbidite du traitement de l’hyperplasie benigne de prostate (HBP) par radiofrequence dans la population generale et tenter de mettre en evidence des facteurs de bon pronostic pour cette technique. Methode Cette etude retrospective a etudie 76 patients consecutifs d’âge moyen 68,9 ans ayant une HBP symptomatique en echec du traitement medical et traites au CHU de Caen entre avril 2004 et octobre 2008. Le statut mictionnel a ete evalue avant et apres traitement par radiofrequence par le score international symptomatique de la prostate (IPSS), le score de qualite de vie (QDV) lie aux symptomes urinaires, la mesure du debit urinaire maximal (Qmax) et du residu postmictionnel (RPM). La fonction erectile a ete evaluee par l’index international de la fonction erectile (IIEF-5). Le critere de jugement principal a ete l’echec du traitement par radiofrequence considere des la reintroduction d’un traitement medical ou par la necessite d’un traitement chirurgical. Les criteres de jugement secondaires ont ete l’amelioration des scores IPSS et de QDV, du Qmax et du RPM. La morbidite per- et postoperatoire a egalement ete evaluee. Resultats Dans la population generale, une amelioration significative du statut mictionnel a ete observee avec un score IPSS moyen passant de 24,7 a 15,1 ( p p p p = 0,0002) respectivement. Le score IIEF-5 a ete ameliore passant de 9,04 a 9,97 ( p = 0,0164). Vingt cinq pour cent de RAU, 7,9 % d’hematuries et 1,3 % de prostatites ont ete observes en postoperatoire. Le taux de retraitement global a ete de 46 % apres 14,6 mois de suivi moyen. Apres stratification en groupes, les patients presentant les criteres d’inclusion a ce traitement ont presente un taux de retraitement de 34,8 % apres 16,2 mois de suivi moyen contre 51 % apres 13,8 mois de suivi chez les patients hors criteres d’inclusion. Sans noter de difference significative entre les retentionnistes et non retentionnistes concernant l’amelioration des parametres subjectifs et objectifs, le taux de retraitement a ete plus important pour les patients retentionnistes (51,2 % apres 11,8 mois de suivi moyen contre 39,4 % apres 18,4 mois) avec une difference significative selon la courbe actuarielle de survie cumulee sans retraitement. Il n’a pas ete retrouve de difference significative chez les patients ayant un lobe median. L’amelioration du Qmax a ete significativement plus importante dans le groupe ayant des prostates de moins de 60 g sans pouvoir mettre en evidence de difference significative concernant les autres parametres. Le taux de retraitement dans ce groupe a ete de 44,4 % apres 14,7 mois de suivi contre 53,8 % apres 13,8 mois chez les patients ayant une prostate de plus de 60 g. La composante irritative a presente une meilleure reponse initiale a ce traitement avec une necessite de retraitement qui a ete retardee par rapport au groupe de patients ayant un syndrome obstructif pur sans noter de difference significative en termes d’amelioration des parametres objectifs et subjectifs. Le taux de retraitement a ete de 63,6 % apres 16,4 mois de suivi moyen contre 51,6 % apres 11,2 mois dans le groupe « obstructif ». Conclusion Le respect des criteres d’inclusion pour le traitement par radiofrequence de l’HBP est important au risque de voir des taux eleves de retraitement.

Resume But Evaluer la faisabilite en chirurgie ambulatoire du traitement de l’hypertrophie benigne de prostate par radiofrequence (TUNA) et sa place en termes d’efficacite parmi les autres techniques chirurgicales mini-invasives. Methodes Cinquante-quatre patients souffrant d’hypertrophie benigne de prostate et en echec du traitement medical ont ete traites par radiofrequence entre septembre 2004 et juin 2007. Parmi eux 28 patients, d’âge moyen 65,8 ans (52–82 ans), ont ete retenus pour un traitement par Transurethral Needle Ablation (TUNA) en chirurgie ambulatoire. Le statut mictionnel a ete evalue avant et apres traitement par TUNA par le score international symptomatique de la prostate (IPSS), le score de qualite de vie (QDV) lie aux symptomes urinaires, la mesure du debit urinaire maximal et du residu postmictionnel. La fonction erectile a ete evaluee par l’index international de la fonction erectile (IIEF-5). Resultats Avec un recul moyen de 12,14 mois, une amelioration significative du statut mictionnel a ete observee avec un score IPSS moyen passant de 22,4 a 9,75 et un score de QDV moyen passant de 4,9 a 1,9. Le debit maximal et le volume urine moyens ont significativement augmente de 8,66 a 14,6 ml/s et de 202 a 248,4 ml, respectivement. Le residu postmictionnel moyen a diminue de 177,4 a 112,2 ml ( p Conclusion La TUNA-therapie est une technique mini-invasive du traitement de l’hypertrophie benigne de prostate realisable en chirurgie ambulatoire et efficace sur la symptomatologie urinaire avec peu de morbidite. Elle est une alternative au traitement medical et ne se substitue pas au traitement chirurgical de reference.

To evaluate the efficacy and morbidity of BPH treatment by radiofrequency in the general population and attempt to identify factors of prognostic value for this technique.This retrospective study examined 76 consecutive patients of mean age 68.9 years with symptomatic BPH in failure of medical treatment and treated at University Hospital of Caen between April 2004 and October 2008. Urine status was assessed before and after treatment with radiofrequency by the international prostate symptom score (IPSS), the quality of life (QOL) score related to urinary symptoms, the measurement of maximum urinary flow (Qmax) and residual postvoid volume (RPV). Erectile function was assessed by the International Index of Erectile Function (IIEF-5). The primary endpoint was treatment failure by radiofrequency regarded as the reintroduction of medical treatment or the need for surgical treatment. The secondary endpoints were the improvement of IPSS and QOL score, Qmax and RPV. Morbidity per and post-operative was also evaluated.A significant improvement in voiding status was observed with an average IPSS score from 24.7 to 15.1 (P0.0001), and a QOL score from 5.2 to 2.9 (P0,0001) in all patients. The Qmax and the RPV were significantly improved from 8.6 to 13.1ml/s (P0.0001) and 177 to 100ml (P=0.0002) respectively. The IIEF-5 score was improved from 9.04 to 9.97 (P=0.0164). Twenty-five percent of acute urinary retention, 7.9% of haematuria and 1.3% of prostatitis were observed postoperatively. The overall retreatment rate was 46% after 14.6 months mean follow-up. When stratified into groups, patients with the inclusion criteria to this treatment showed a treatment rates of 34.8% after 16.2 months mean follow-up against 51% after 13.8 months of monitoring patients outside the inclusion criteria. Without showing significant difference between retentionist and no retentionist concerning subjective and objective parameters, the rate of retreat was more important for retentionist (51.2% after 11.8 months of mean follow against 39.4% after 18.4 months) with a significant difference on the actuarial cumulative survival curve without reprocessing. There was no significant difference found in patients with a median lobe. The results showed an improvement in Qmax significantly greater in the group with prostates less than 60 g without being able to demonstrate significant differences in other parameters. The retreatment rates in this group was 44.4% after 14.7 months of follow-up against 53.8% after 13.8 months of follow-up in the group of patients with prostate over 60 g. Moreover, the irritative component made a better initial response to treatment with a need for retreatment delayed compared to the group of patients with obstructive symptom, without noting significant differences in terms of improvement of objective and subjective parameters. The rate of retreatment was 63.6% after 16.4 months of mean follow and 51.6% after 11.2 months in the "obstructive" group.High rates of reprocessing are observed in the treatment of BPH by radiofrequency if inclusion criteria are not respected.

To assess the feasibility of ambulatory surgery in the treatment of benign prostatic hyperplasia using radio frequency (TUNA) and evaluate its place in terms of efficiency among other minimally invasive surgical techniques.Fifty-four patients suffering from benign prostatic hyperplasia and for whom medical treatment was ineffective, were treated with radio frequency between September 2004 and June 2007. Among them, 28 patients, whose average age was 65.8 (aged 52-82), were selected for Transurethral Needle Ablation (TUNA) as outpatients. Urine status was assessed before and after TUNA treatment using the International Prostate Score System, the Quality Of Life-score to urinary symptoms, the measures of the maximal flow rate and of the residual urine. The erectile function was assessed using the five-item version of the International Index of Erectile Function (IIEF-5).With an average regression of 12.14 months, a significant improvement in urine status was observed with an average IPSS score passing from 22.4 to 9.75 and an average quality of life score passing from 4.9 to 1.9. The maximum flow rate and average flow volume increased significantly from 8.66 to 14.6 ml/s and from 202 to 248.4 ml respectively. Average urine residue was reduced from 177.4 to 112.2 ml (p0.05). The IIEF-5 score did not increase significantly (14.1 versus 12.8). There were no cases of patients being rehospitalised. One case of prostatitis and six cases of acute urinary retention were observed at the postoperative stage. The rate of retreat was 21.4%.TUNA treatment is a minimally invasive technique of benign prostatic hyperplasia which can be carried out in ambulatory surgery and which is effective for urinary symptoms with little risk of morbidity. It is an alternative to medical treatment and does not replace planned surgical treatment.