A meta-analysis of trials of transurethral needle ablation for treating symptomatic benign prostatic hyperplasia.

This section opens with two meta-analyses, the first into the use of transurethral needle ablation (TUNA) for treating symptomatic BPH and the second into comparative trials between transurethral electrovaporization and TURP. The first of these meta-analyses showed that despite a variety of trial methods, not all were satisfactory. TUNA was effective in improving symptoms and flow rates. The place of this therapy in the treatment of symptomatic BPH is suggested. In the second meta-analysis, methodological shortcomings of the various trials are again discussed. The possible advantages of both of these treatments are described, but the authors suggest that there is a need for future well-designed trials with extended follow-up. This seems to be the ultimate conclusion of a significant number of the meta-analysis into technological treatments for symptomatic BPH. To investigate the short- and long-term effectiveness of transurethral needle ablation (TUNA) of the prostate for clinical benign prostatic hyperplasia (BPH), using a meta-analysis of all clinical studies involving TUNA. Data were extracted from two randomized trials, two non-randomized observational protocols and 10 single-arm studies conducted on TUNA, according to a determined protocol. The meta-analysis was based on the change in the mean score at the end of study from that at baseline. The estimation of the effects from the meta-analysis used a multilevel model including random effects for the studies. In all studies the patients recruited had severe lower urinary tract symptoms and a mean International Prostate Symptom Score (IPSS) of > 20 before treatment. The effect of TUNA was to halve the mean IPSS at 1 year after treatment and, although there was a slight tendency for the IPSS to increase in all arms from year 1 to year 5, this decrease by half was maintained at 5 years. The maximum urinary flow rate (Qmax) also increased by ≈ 70% from baseline to 1 year and in virtually all studies the mean Qmax approached or exceeded 15 mL/s. Although there was a tendency for Qmax to decline slightly over time, the mean Qmax 5 years after treatment was > 50% over baseline. This meta-analysis shows that TUNA is an effective and minimally invasive treatment for men with clinical BPH, even when the symptoms are severe. There is a significant improvement in symptoms and flow rate after 1 year which persists for at least 5 years. TUNA therapy would appear to be an alternative to surgery and an attractive option for men who do not wish to undergo long-term medical therapy, are poor candidates for surgery or are concerned about the side-effects of TURP. [ABSTRACT FROM AUTHOR]