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Gastroenterology
Benign Prostatic Hyperplasia



Trans Urethral Needle Ablation of the Prostate - (TUNA)
BPH, just a plumbing problem...
Prostate

BPH, or Benign Prostatic Hyperplasia, is not really a disease and has nothing to do with cancer of the prostate. Rather, it is just a plumbing problem. In simplistic terms, you can think of the prostate as walnut-sized donut-shaped gland which lies just beneath a man's urinary bladder. Like a donut, it has a hole in the center. The tube that drains the bladder out through the penis is called the urethra . To do this, the urethra must pass through the hole in the center of the prostate. As a man ages, the prostate usually becomes enlarged - both outward (which makes the prostate bigger) and inward (which may narrow the hole and squeeze the urethra). This non-cancerous enlargement is called Benign Prostatic Hyperplasia, or BPH.

How common is BPH?

Prostatic enlargement is extremely common in older men. It usually starts at around age forty or so and keeps on going on until the day we die. Published estimates, and our experience over twenty to twenty-five years of urology practice, indicate that around 50% to 90% of men over fifty years of age experience such enlargement.

What are the symptoms of BPH?

Some lucky men suffer few if any symptoms, but most men experience at least some change in their pattern of urination secondary to the enlargement. In rare cases, the prostate gland can block the urine channel so severely that kidney failure and death occur. In most cases however, the symptoms are more appropriately labeled as "bothersome." Patients note a slower urinary stream which results in a longer time to empty their bladders. Often there is urinary "urgency" or the need to urinate very quickly; carried further, urgency results in "urgency incontinence" or leakage of urine before the patient reaches a commode. "Nocturia" or the regular need to urinate often at night is a frequent symptom. Dribbling immediately after urinating is often noted. Many men simply adapt to these symptoms especially if they are mild. However, for great numbers of men the symptoms actually interfere with their daily activities and lessen the quality of life.

Common Symptoms Associated with BPH:

  • Frequent need to urinate
  • Sudden need to urinate
  • Interrupted sleep to urinate at night
  • Weak, variable or dribbling stream
  • Need to strain or push bladder to urinate
  • Difficulty beginning urination
Surgical treatment for BPH - TURP

In the past, standard treatment for prostate enlargement usually meant undergoing a surgical procedure called a Transurethral Resection of the Prostate or TURP. Literally millions of TURPs have been performed in the United States since they became popular in the 1930's and the vast majority have been quite successful. However, large studies have shown that approximately 10% - 15% of men undergoing a TURP will experience a significant complication such as impotence, incontinence, or blood loss great enough to require a transfusion. Furthermore, a TURP requires either spinal or general anesthesia, a hospital stay of two to four days, and four to six weeks of recuperation.

Medical treatment for BPH

Because of these limitations, several alternatives to the TURP have been developed. These alternatives include medications as well as less invasive surgical procedures. Medications such as Proscar (finasteride), Hytrin (terazosin), Cardura (doxazosin) and Flomax (tamsulosin) are effective in some men but not all and furthermore, must be taken for the remainder of a patient's life. There are three disadvantage to medical therapy for BPH:

  • These medications lose their effectiveness when they are discontinued. Many men would prefer to avoid life-long medical therapy.
  • A significant percentage of men develop side effects from Proscar, Hytrin, Cardura, and Flomax.
  • Most importantly, these medications do not halt the primary problem - progressive enlargement of the prostate. They just help the symptoms and really mask the underlying problem.

TUNA - a new alternative to TURP

TUNA

Until recently, alternative surgical procedures really did not seem to provide much true improvement over the TURP in terms of risks, anesthesia requirements, and/or hospital stays. Now, a new procedure termed Trans Urethral Needle Ablation (TUNA) appears quite promising. I have been performing TUNA for approximately 2 to 3 years and, in fact, was the first urologist in southwestern Pennsylvania to offer this procedure. I currently have the most experience locally with TUNA.

How is TUNA performed?

During TUNA, the interior of the prostate is treated with low levels of radiofrequency energy in a manner which causes prostatic tissue coagulation or destruction. In the hands of a properly trained urologic surgeon, the procedure is rather simple to perform. Operating time is usually approximately thirty minutes. The procedure can almost always be performed using only local anesthesia and intra-venous sedation and is performed as an out-patient. During the TUNA procedure, a special lighted scope is inserted that employs two tiny needles that penetrate the prostate without damaging the wall of the urethra. The urologist then directs the needles into position and releases a controlled burst of radiofrequency energy which heats the enlarged prostate tissue to about 195 degrees without affecting nearby nerves, muscles or membranes. The two needles are moved into several different locations and the treatment repeated which destroys enough prostatic tissue to "open the pipes" a bit. Over a period of a few months, the prostate shrinks away from the middle hole and opens the passageway and the narrowing in the urethra is reduced. Patients are sent home with a small urinary catheter which is removed two to three days later and they can resume normal activity almost immediately.

Increased urinary flow

Trans Urethral Needle Ablation was until recently relatively new to the United States. However, large studies from Belgium and Canada had clearly demonstrated its value. Furthermore, a recently completed study from twelve American medical centers has in fact again convincingly shown significant subjective and objective improvements in urinary patterns following TUNA. These studies indicate a very significant improvement in peak urine flow rates, symptom score and quality of life after the procedure by virtue of an increase of urinary flow to normal levels by a year and decrease in residual urine to normal levels by the same period of time. More importantly, complications previously seen with the TURP such as significant bleeding, retrograde ejaculations, incontinence, and/or impotence are almost never noted.

Approved by the FDA and Medicare

More than 12,000 TUNA Procedures have been performed worldwide, and now TUNA is fully approved by the Food and Drug Administration for treating the symptoms of prostatic enlargement. Recently, it has been added to the list of procedures covered by Medicare.

While medications and TURPs will continue to play a role in helping some men with prostate troubles, it is apparent that Trans Urethral Needle Ablation appears to offer an intriguing, simple, and safe alternative to conventional therapy for men with symptomatic prostatic enlargement. If you would like more information about TUNA, please contact our office at the number listed.

Copyright:

Robert W. Doebler, M.D., F.A.C.S.

Valley Urological Associates
Sewickley Valley Hospital Office
Sewickley Valley Hospital - 4th Floor
701 Broad Street
Sewickley, PA 15143
412 741-8025


Text & Images Courtesy of Three Rivers Endoscopy Center
© Dr. Robert Fusco, Three Rivers Endoscopy Center, All Rights Reserved





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