TUNA – Transurethral needle ablation for BPH

Findings by SBU Alert

This is a translation of version 1, published on February 2, 2000. The latest version of this report is not available in English.

Technology and target group

During the 1990s several new methods were introduced to treat enlargement of the prostrate gland, ie, benign prostatic hyperplasia (BPH). One of the most recent methods involves heat therapy via a needle in the urethra (Transurethral needle ablation – TUNA) to treat urinary obstructions caused by BPH. Annually, about 25 000 men are diagnosed with BPH in Sweden. In 1996, Sweden reported 7 100 prostatic hyperplasia operations, mainly by transurethral prostatic resection (TUR-P). TUNA is used primarily in patients with moderate enlargement of the lateral lobes of the prostate gland. These cases account for somewhat over 50% of the patients who currently are candidates for one of the available surgical procedures.

Patient benefit

The method has been studied in a randomized controlled trial and in several non-controlled studies. The findings suggest that TUNA has few side effects and yields relatively good results on urinary obstructions in the short term. A long-term followup shows that 20% of those treated with TUNA require additional treatment within 2 years.

Economic aspects

Health economic assessments of the method are not available. Introduction of the method is estimated to have only a minor economic impact on health services.

Scientific evidence

Scientific documentation is poor* regarding patient benefits from TUNA measured in terms of risks and short-term effects. Documentation is poor* as regards long-term effects and cost effectiveness.

An important aspect related to treatment by TUNA and other methods concerns the long-term effects on urinary obstructions and consequently the percentage of patients who later require surgery. To address this issue, and the issue of total care requirements, a followup time of at least 3 to 5 years is needed. Hence it is essential to study both the long-term results and costs in randomized clinical trials.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with Assoc. Prof. Peter Wiklund, Karolinska Hospital and has been reviewed by the Expert Group of Urology, National Board of Health and Welfare.

The full report is available only in Swedish.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

References

1. Bruskewitz R, Issa MM, Roehborn CG, Naslund MJ, Perez-Marrero R 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. Journal of Urology 1998;159(5):1588-93.
2. Burkhard FC, Roehrborn CG, Bruskewitz R, Issa MM, Perez-Marrero R et al. The effect of TUNA and TURP of the prostate on pressure flow urodynamic parameters: Analysis in the US randomized study (submitted).
3. Chappel C, Issa MM, Woo H. Transurethral Needle Ablation TUNA. Eur Urol 1999;35:119-128.
4. Jepsen JV, Bruskewitz RC. Recent developments in the surgical management of benign prostatic hyperplasia. Urology 1998;51(suppl 4A):23-31.
5. Naslund MJ. A cost comparison of TUNA versus TURP. Journal of Urology 1997;157:A610.
6. Puppo P. Long-term effects on bph of medical and instrumental therapies. Eur Urol 2001;39(suppl 6):2-6.
7. Schatzl G, Madersbacher S, Djavan B, Lang T, Marberger M. Two-year result of transurethral resection of the prostate versus four "less invasive" treatment options. Eur Urol 2000;37:695-701.