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Mutam Issa - One of the best experts on this subject based on the ideXlab platform.
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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
The Journal of Urology, 2004Co-Authors: Brian Hill, Mutam Issa, Reginald C Bruskewitz, Claus G Roehrborn, Ramon Perezmarrero, William Belville, Martha Terris, Michael J NaslundAbstract:Purpose: We report the 5-year efficacy and safety of Transurethral Needle Ablation of the prostate (TUNA) compared to Transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Materials and Methods: A total of 121 men 50 years or older with LUTS secondary to BPH a minimum of 3 months in duration were enrolled in this prospective, randomized clinical trial at 7 medical centers across the United States. Of the participants 65 (54%) were randomly selected to receive TUNA and 56 (46%) were selected to receive TURP. International Prostate Symptom Score, quality of life, peak urinary flow rate, post-void residual urinary volume, and prostate size and configuration were evaluated before the procedure and then annually for 5 years after the procedure. Adverse events were also recorded throughout the study. Results: Improvement from baseline for TUNA and TURP retained statistical significance at each interval for International Prostate Symptom Score, quality of life and peak flow rate. Post-void residual volume was statistically significant at all time points for TURP and at year 5 for TUNA. The TURP group reported 41% retrograde ejaculation, while the TUNA group reported none. The incident of erectile dysfunction, incontinence and stricture formation was also greater in TURP than in TUNA cases with significantly fewer adverse events for TUNA than for TURP. Conclusions: The results of this study demonstrate stable treatment outcomes after 5 years of followup and suggest that TUNA is an attractive treatment option for men with LUTS due to BPH.
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prospective multicenter study of transperineal prostatic block for Transurethral Needle Ablation of the prostate
Urology, 2000Co-Authors: Mutam Issa, Barry S Stein, Ralph C Benson, Dean L KnollAbstract:The choice of anesthesia during thermal therapy of the prostate plays a significant role in the morbidity profile, patient convenience, and cost. We report 39 men with symptomatic benign prostatic hyperplasia who underwent Transurethral Needle Ablation of the prostate under transperineal prostatic block. This method of local anesthesia proved safe, convenient, and satisfactory during the procedure.
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Transurethral Needle Ablation of the prostate
2000Co-Authors: Mutam IssaAbstract:Transurethral Needle Ablation (TUNA) is a minimally invasive radiofrequency thermal therapy for the treatment of symptomatic benign prostatic hyperplasia (BPH). The procedure achieves tissue Ablation with temperatures exceeding 60°C while selectively preserving the prostatic urethra. Significant objective and subjective improvements are seen, as determined by the changes in symptom scores and peak flow rates. The objective of this chapter is to present an overview of radiofrequency (RF) thermal therapy, with a summary of the clinical results, as it applies to the treatment of BPH.
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a prospective study of transperineal prostatic block for Transurethral Needle Ablation for benign prostatic hyperplasia the emory university experience
The Journal of Urology, 1999Co-Authors: Mutam Issa, Marcos R Perezbrayfield, John A Petros, Katrina Anastasia, Anthony J Labadia, Elayne L MillerAbstract:PURPOSE: We evaluate the feasibility, effectiveness and role of transperineal prostate block in providing anesthesia during minimally invasive radio frequency thermal therapy of the prostate. MATERIALS AND METHODS: A total of 38 consecutive patients undergoing Transurethral Needle Ablation for symptomatic benign prostatic hyperplasia were entered in this prospective study. All patients received transperineal prostatic block as the main method of anesthesia. A mixture of equal volumes of 1% lidocaine and 0.25% bupivacaine, each with epinephrine (1:100,000 concentration ratio) was used. Pain control during the instillation of transperineal prostatic block and Transurethral Needle Ablation was assessed using a 10-point linear analog pain scale and questionnaire. RESULTS: Median patient age was 65.5 years (range 47 to 79), with 21% of men in the eighth decade of life. Median American Urological Association symptom score was 25.0 (range 14 to 35), bother score was 20.0 (11 to 28), quality of life score was 4.0 (3 to 6) and peak urinary flow rate was 8.9 cc per second (3.5 to 15.7). Median sonographic prostate volume was 35.0 cc (range 17 to 129). Median volume of anesthetic agent used was 40.0 cc (range 30 to 60) per case (1.1 cc solution per 1 cc prostate tissue). No adverse events were encountered. Median pain score was 3.3 (range 1 to 6) during instillation of transperineal prostatic block and 1.0 (0 to 6) during Transurethral Needle Ablation. Transperineal prostatic block proved highly effective and was a satisfactory method of anesthesia during Transurethral Needle Ablation as judged by postoperative questionnaire. No sedation, narcotic or analgesia was required. All procedures were performed in the outpatient cystoscopy suite or office setting without support of an anesthesia team or conscious sedation monitoring. CONCLUSIONS: Transperineal prostatic block is a safe, convenient, effective and satisfactory method of minimally invasive anesthesia for Transurethral Needle Ablation of the prostate in an outpatient office setting. Elderly patients and those at high surgical risk can be treated safely using this approach. Considerable cost saving is seen secondary to omission of charges related to anesthesia team support, recovery room facility and conscious sedation monitoring.
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A PROSPECTIVE STUDY OF TRANSPERINEAL PROSTATIC BLOCK FOR Transurethral Needle Ablation FOR BENIGN PROSTATIC HYPERPLASIA: THE EMORY UNIVERSITY EXPERIENCE
The Journal of Urology, 1999Co-Authors: Mutam Issa, John A Petros, Katrina Anastasia, Anthony J Labadia, Marcos R. Perez-brayfield, L. Elayne MillerAbstract:Purpose:: We evaluate the feasibility, effectiveness and role of transperineal prostate block in providing anesthesia during minimally invasive radio frequency thermal therapy of the prostate.Materials and Methods:: A total of 38 consecutive patients undergoing Transurethral Needle Ablation for symptomatic benign prostatic hyperplasia were entered in this prospective study. All patients received transperineal prostatic block as the main method of anesthesia. A mixture of equal volumes of 1% lidocaine and 0.25% bupivacaine, each with epinephrine (1:100,000 concentration ratio) was used. Pain control during the instillation of transperineal prostatic block and Transurethral Needle Ablation was assessed using a 10-point linear analog pain scale and questionnaire.Results:: Median patient age was 65.5 years (range 47 to 79), with 21% of men in the eighth decade of life. Median American Urological Association symptom score was 25.0 (range 14 to 35), bother score was 20.0 (11 to 28), quality of life score was 4....
Claude Schulman - One of the best experts on this subject based on the ideXlab platform.
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possible mechanisms of action of Transurethral Needle Ablation of the prostate on benign prostatic hyperplasia symptoms a neurohistochemical study
The Journal of Urology, 1997Co-Authors: Alexandre R. Zlotta, Gil Raviv, Marieodile Peny, Jean Christophe Noel, J Haot, Claude SchulmanAbstract:ABSTRACTPurpose: Transurethral Needle Ablation of benign prostatic hypertrophy (BPH) is a rapid, anesthesia-free outpatient procedure using low level radiofrequency energy that produces coagulative necrosis lesions at temperatures of approximately 100C. Clinically, significant improvement in objective and subjective parameters has been observed in BPH patients. Transurethral Needle Ablation has also been shown to be effective in relieving urinary retention. However, the precise mechanism of action of this procedure remains to be clarified. Ablation could produce its action on the dynamic component of the infravesical outlet obstruction. We analyzed the possible effects of Transurethral Needle Ablation on the intraprostatic innervation.Materials and Methods: Histological sections from 10 open prostatectomy specimens (BPH) recovered 1 to 46 days after Transurethral Needle Ablation were stained with hematoxylin and eosin and an immunohistochemical technique, using antibodies against S100 proteins and nonspec...
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Transurethral Needle Ablation of the prostate clinical experience in patients in urinary acute retention
BJUI, 1996Co-Authors: Alexandre R. Zlotta, Marieodile Peny, C Matos, Claude SchulmanAbstract:Objective To evaluate the clinical outcome of patients in urinary retention due to benign prostatic enlargement (BPE) treated using Transurethral Needle Ablation (TUNA), an outpatient procedure requiring only local intra-urethral anaesthesia and intravenous sedoanalgesia. Patients and methods The TUNA technique was used in 38 patients in acute retention due to BPE, 34 of whom were a poor surgical risk. A special cystoscopic catheter device delivered low-level radiofrequency (RF) energy interstitially to a localized area of the prostate, producing necrotic lesions within the prostatic parenchyma. After treatment, all men were evaluated using urinary flow rates, residual urine volume, the International Prostate Symptom Score and quality of life score at 1, 3 and 6 months. Results The mean prostate size was 43.1 g (range 18–90). Tolerance of the procedure when using topical anaesthetic and intravenous sedation was excellent. Of the 38 patients treated using TUNA, 30 (79%) resumed voiding within a mean of 8.7 days (range 2–27). After 6 months, the sustained mean peak flow rate was 10.4±3.4 mL/s and the mean residual volume was 76±45 mL. Five of the patients who did not resume voiding after TUNA underwent retropubic prostatectomy and one patient underwent TURP. The mean prostate size in these patients was 55.7 g. Failure to void was associated with the treatment of too few areas of the prostate for its volume. Conclusion This study demonstrated that TUNA is highly effective in relieving patients in urinary retention due to BPE and seems particularly suitable for treating patients who are at greater risk during surgery.
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Transurethral Needle Ablation of the prostate a new treatment of benign prostatic hyperplasia using interstitial low level radiofrequency energy
Current Opinion in Urology, 1995Co-Authors: Claude Schulman, Alexandre R. ZlottaAbstract:Transurethral Needle Ablation is a new method of treating benign prostatic hyperplasia. Needles on a urethral catheter deliver low-level radiofrequency power directly to a localized area of the prostate. Extensive coagulative necrosis is produced by central lesion temperatures above 100°C. The Needles have adjustable shields to protect the urethra if necessary. The instrument is positioned by direct vision using fibre optics. Clinical and pathological studies of Transurethral Needle Ablation have shown the following: (1) that it is feasible and safe; (2) that it can create localized controlled necrotic lesions, as demonstrated by histopathological studies of operative specimen and magnetic resonance imaging; (3) an excellent tolerance of the procedure as an anaesthesia-free outpatient treatment; and (4) an excellent improvement in objective and subjective parameters, such as peak flow rate and International Prostate Symptom Score, after 6 months. Transurethral Needle Ablation is a promising, anaesthesia-free, alternative treatment for men with symptomatic benign prostatic hyperplasia, but long-term outcome will require further evaluation over several years.
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Transurethral Needle Ablation of the prostate for treatment of benign prostatic hyperplasia early clinical experience
Urology, 1995Co-Authors: Claude Schulman, Alexandre R. ZlottaAbstract:Objectives. Many attempts have been made to develop a method for treatment of benign prostatic hyperplasia (BPH) that is minimally invasive, efficacious, and low-cost. Transurethral Needle Ablation (TUNA) is a new, fast outpatient anesthesia-free procedure, using interstitial low-level radio frequency energy to produce a temperature above 100°C. We describe our early clinical experience with TUNA as an outpatient procedure.
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Transurethral Needle Ablation tuna histopathological radiological and clinical studies of a new office procedure for treatment of benign prostatic hyperplasia
Acta urologica Belgica, 1994Co-Authors: Luc Hourriez, Alexandre R. Zlotta, Claude SchulmanAbstract:: Many attempts have been made to develop a method for treating benign prostatic hyperplasia (BPH) that is minimally invasive, efficacious, and low cost. The Transurethral Needle Ablation (TUNA) device has recently been developed to treat BPH by selectively ablating hyperplastic prostatic tissue. A special catheter incorporates Needles that deliver low-level radiofrequency power directly to a very localized area of the prostate. The Needles have adjustable shields to protect the urethra if desired or necessary. It is positioned via transrectal ultrasound or direct vision. A pilot study was performed in patients to evaluate TUNA feasibility via histopathological measurement of thermal lesion size and TUNA safety. Fifty patients have been treated, twenty-five patients were treated using TUNA prior to scheduled retropubic prostatectomy. The surgical prostatic specimens were recovered from 1 day to 1 month after TUNA, were stepsectioned, and examined histologically. Patients were 69-years-old on average with prostate weight varying from 14 to 88 g. The TUNA procedure averaged 30 minutes, 4 lesion treatments per prostate, and 4-15 W of power applied for 3 to 5 minutes. Proximal lesion temperature was about 40-70 degrees C with central lesion temperatures of about 110 degrees C with central lesion temperatures of about 110 degrees C. Urethral temperature averaged 37-42 degrees C and rectal temperature remained unchanged. Macroscopic examination of the specimens demonstrated localized lesions averaging 12 x 7 mm for 3 min and 10 x 17 for 5 min treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Alexandre R. Zlotta - One of the best experts on this subject based on the ideXlab platform.
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Transurethral Needle Ablation of the Prostate
Smith's Textbook of Endourology: 3rd Edition, 2012Co-Authors: Alexandre R. Zlotta, Cynthia KukAbstract:PURPOSE OF REVIEW: The review aims at reviewing the evidence published in the peer review literature or otherwise available with particular focus on articles published over the last 2 years on the Transurethral Needle Ablation of the prostate in the treatment of benign prostatic hyperplasia. Prospective noncomparative and comparative studies as well as meta-analyses were considered. Information from the European Real Life database on Transurethral Needle Ablation was also included. RECENT FINDINGS: The evidence currently available confirms a clinically relevant improvement of lower urinary tract symptoms and quality of life. Impact on voiding dynamics including flow rates, detrusor pressure at maximum flow and postvoid residual, as well on prostate volume, remains marginal. SUMMARY: All major guidelines in the management of lower urinary tract symptoms in patients with benign prostatic enlargement include Transurethral Needle Ablation of the prostate as a valuable treatment option in patients with severe symptoms and low degree of bladder outlet obstruction, patients at high risk for surgery and patients who wish to avoid surgery or regional/general anaesthesia.
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possible mechanisms of action of Transurethral Needle Ablation of the prostate on benign prostatic hyperplasia symptoms a neurohistochemical study
The Journal of Urology, 1997Co-Authors: Alexandre R. Zlotta, Gil Raviv, Marieodile Peny, Jean Christophe Noel, J Haot, Claude SchulmanAbstract:ABSTRACTPurpose: Transurethral Needle Ablation of benign prostatic hypertrophy (BPH) is a rapid, anesthesia-free outpatient procedure using low level radiofrequency energy that produces coagulative necrosis lesions at temperatures of approximately 100C. Clinically, significant improvement in objective and subjective parameters has been observed in BPH patients. Transurethral Needle Ablation has also been shown to be effective in relieving urinary retention. However, the precise mechanism of action of this procedure remains to be clarified. Ablation could produce its action on the dynamic component of the infravesical outlet obstruction. We analyzed the possible effects of Transurethral Needle Ablation on the intraprostatic innervation.Materials and Methods: Histological sections from 10 open prostatectomy specimens (BPH) recovered 1 to 46 days after Transurethral Needle Ablation were stained with hematoxylin and eosin and an immunohistochemical technique, using antibodies against S100 proteins and nonspec...
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Transurethral Needle Ablation of the prostate clinical experience in patients in urinary acute retention
BJUI, 1996Co-Authors: Alexandre R. Zlotta, Marieodile Peny, C Matos, Claude SchulmanAbstract:Objective To evaluate the clinical outcome of patients in urinary retention due to benign prostatic enlargement (BPE) treated using Transurethral Needle Ablation (TUNA), an outpatient procedure requiring only local intra-urethral anaesthesia and intravenous sedoanalgesia. Patients and methods The TUNA technique was used in 38 patients in acute retention due to BPE, 34 of whom were a poor surgical risk. A special cystoscopic catheter device delivered low-level radiofrequency (RF) energy interstitially to a localized area of the prostate, producing necrotic lesions within the prostatic parenchyma. After treatment, all men were evaluated using urinary flow rates, residual urine volume, the International Prostate Symptom Score and quality of life score at 1, 3 and 6 months. Results The mean prostate size was 43.1 g (range 18–90). Tolerance of the procedure when using topical anaesthetic and intravenous sedation was excellent. Of the 38 patients treated using TUNA, 30 (79%) resumed voiding within a mean of 8.7 days (range 2–27). After 6 months, the sustained mean peak flow rate was 10.4±3.4 mL/s and the mean residual volume was 76±45 mL. Five of the patients who did not resume voiding after TUNA underwent retropubic prostatectomy and one patient underwent TURP. The mean prostate size in these patients was 55.7 g. Failure to void was associated with the treatment of too few areas of the prostate for its volume. Conclusion This study demonstrated that TUNA is highly effective in relieving patients in urinary retention due to BPE and seems particularly suitable for treating patients who are at greater risk during surgery.
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Transurethral Needle Ablation of the prostate a new treatment of benign prostatic hyperplasia using interstitial low level radiofrequency energy
Current Opinion in Urology, 1995Co-Authors: Claude Schulman, Alexandre R. ZlottaAbstract:Transurethral Needle Ablation is a new method of treating benign prostatic hyperplasia. Needles on a urethral catheter deliver low-level radiofrequency power directly to a localized area of the prostate. Extensive coagulative necrosis is produced by central lesion temperatures above 100°C. The Needles have adjustable shields to protect the urethra if necessary. The instrument is positioned by direct vision using fibre optics. Clinical and pathological studies of Transurethral Needle Ablation have shown the following: (1) that it is feasible and safe; (2) that it can create localized controlled necrotic lesions, as demonstrated by histopathological studies of operative specimen and magnetic resonance imaging; (3) an excellent tolerance of the procedure as an anaesthesia-free outpatient treatment; and (4) an excellent improvement in objective and subjective parameters, such as peak flow rate and International Prostate Symptom Score, after 6 months. Transurethral Needle Ablation is a promising, anaesthesia-free, alternative treatment for men with symptomatic benign prostatic hyperplasia, but long-term outcome will require further evaluation over several years.
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Transurethral Needle Ablation of the prostate for treatment of benign prostatic hyperplasia early clinical experience
Urology, 1995Co-Authors: Claude Schulman, Alexandre R. ZlottaAbstract:Objectives. Many attempts have been made to develop a method for treatment of benign prostatic hyperplasia (BPH) that is minimally invasive, efficacious, and low-cost. Transurethral Needle Ablation (TUNA) is a new, fast outpatient anesthesia-free procedure, using interstitial low-level radio frequency energy to produce a temperature above 100°C. We describe our early clinical experience with TUNA as an outpatient procedure.
S D Edwards - One of the best experts on this subject based on the ideXlab platform.
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Transurethral Needle Ablation tuna of the prostate using low level radiofrequency energy an animal experimental study
European Urology, 1993Co-Authors: B Goldwasser, Hugh R Sharkey, Jacob Ramon, Santiago Engelberg, Bruno Strul, D Ohad, J S Rasor, S D EdwardsAbstract:: Transurethral Needle Ablation of the canine prostate using low level radiofrequency energy was examined for efficacy and safety in a two-stage experimental study. Eleven mongrel dogs were treated via the bladder neck and prostatic urethra using a specially designed catheter through which Needle antennas were advanced into the prostatic tissue. A radiofrequency energy source was connected to the catheter and used to create tissue Ablation. In the first 5 dogs this was found to be feasible. Necrotic lesions were created around the Needle antennas. Typically, lesions were 1 cm in diameter and conical in shape. The actual size of the lesion was directly related to power level used, time of Ablation and length of Needle deployment. In the next 6 dogs temperatures were simultaneously measured in the prostatic urethra and rectum. The dogs were sacrificed 0, 2, 2, 14, 28 and 30 days following the experiments and the bladder, prostate and anterior rectal wall were removed en bloc and examined macroscopically and histopathologically for any changes. It was found that urethral temperatures increased to 46.1 degrees C on the average while rectal temperature did not rise during the entire experiment. The lesions found in the prostate were similar to those found in the first 5 dogs. No macroscopic or histopathologic changes were noted at the bladder base, anterior rectal wall or in the distal prostatic urethra. It was concluded that prostatic tissue Ablation in the canine model can be achieved safely and could justify the start of human trials.
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Transurethral Needle Ablation tuna thermal gradient mapping and comparison of lesion size in a tissue model and in patients with benign prostatic hyperplasia
European Urology, 1993Co-Authors: J S Rasor, Alexandre R. Zlotta, S D Edwards, Claude SchulmanAbstract:: A new device has been development for treating benign prostatic hyperplasia (BPH) that is performed as an outpatient procedure. the device (Transurethral Needle Ablation or TUNA) employs Needles that deliver low-level radiofrequency (RF) power locally at high temperature to ablate hyperplastic prostate tissue. During the TUNA procedure the temperature proximal to the Needle tips is measured with thermocouples within the Needle's protective shields and urethral temperature is measured via a thermocouple contained within the catheter tip. Tissue impedance is also measured by the TUNA catheter since it is well known from other thermal treatment methods that thermal destruction of prostatic tissue depends upon a particular prostate's tissue composition and thermoregulation. Because of this variation in prostates, a nomogram guide for setting the TUNA device was created using a turkey breast tissue model. Lesion sizes created at particular settings in the turkey breast model were similar to those created at the same settings in patients with BPH. In addition, local thermal gradients within the TUNA lesions were visualized and mapped using an infrared thermal imaging system which demonstrated that central lesion temperature with the device is approximately 80-100 degrees C.
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Transurethral Needle Ablation tuna safety feasibility and tolerance of a new office procedure for treatment of benign prostatic hyperplasia
European Urology, 1993Co-Authors: Claude Schulman, Alexandre R. Zlotta, Jean Christophe Noel, Luc Hourriez, J S Rasor, S D EdwardsAbstract:: Many attempts have been made to develop a method for treating benign prostatic hyperplasia (BPH) that is minimally invasive, efficacious, and low cost. The Transurethral Needle Ablation (TUNA) device has recently been developed to treat BPH by selectively ablating hyperplastic prostatic tissue. A special catheter incorporates Needles that deliver low-level radiofrequency power directly to a very localized area of the prostate. The Needles have adjustable shields to protect the urethra if desired or necessary. It is positioned via transrectal ultrasound or direct vision. A pilot study was performed in patients to evaluate TUNA feasibility via histopathological measurement of thermal lesion size and TUNA safety by: (1) monitoring urethral and rectal temperatures; (2) assessing the ability to localize lesions, and (3) determining patient tolerance of the procedure without anesthesia. Twenty patients were treated using TUNA prior to scheduled retropubic prostatectomy. The surgical prostatic specimens were recovered from 1 day to 1 month after TUNA, were step-sectioned, and examined histologically. Patients were 68 years old on average with prostate weight varying from 14 to 88 g. The TUNA procedure averaged 27 min, 4 lesion treatments per prostate, and 4-15 W of power applied for 3 min. Proximal lesion temperature was about 40-50 degrees C with central lesion temperatures of about 80-100 degrees C. Urethral temperature averaged 37-42 degrees C and rectal temperature remained unchanged. Macroscopic examination of the specimens demonstrated localized lesions averaging 12 x 7 mm. Microscopic examination showed larger lesions of extensive coagulative necrosis averaging 30 x 15 mm. Specific immunohistochemical staining showed destruction of all tissue components.(ABSTRACT TRUNCATED AT 250 WORDS)
J S Rasor - One of the best experts on this subject based on the ideXlab platform.
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Transurethral Needle Ablation tuna of the prostate using low level radiofrequency energy an animal experimental study
European Urology, 1993Co-Authors: B Goldwasser, Hugh R Sharkey, Jacob Ramon, Santiago Engelberg, Bruno Strul, D Ohad, J S Rasor, S D EdwardsAbstract:: Transurethral Needle Ablation of the canine prostate using low level radiofrequency energy was examined for efficacy and safety in a two-stage experimental study. Eleven mongrel dogs were treated via the bladder neck and prostatic urethra using a specially designed catheter through which Needle antennas were advanced into the prostatic tissue. A radiofrequency energy source was connected to the catheter and used to create tissue Ablation. In the first 5 dogs this was found to be feasible. Necrotic lesions were created around the Needle antennas. Typically, lesions were 1 cm in diameter and conical in shape. The actual size of the lesion was directly related to power level used, time of Ablation and length of Needle deployment. In the next 6 dogs temperatures were simultaneously measured in the prostatic urethra and rectum. The dogs were sacrificed 0, 2, 2, 14, 28 and 30 days following the experiments and the bladder, prostate and anterior rectal wall were removed en bloc and examined macroscopically and histopathologically for any changes. It was found that urethral temperatures increased to 46.1 degrees C on the average while rectal temperature did not rise during the entire experiment. The lesions found in the prostate were similar to those found in the first 5 dogs. No macroscopic or histopathologic changes were noted at the bladder base, anterior rectal wall or in the distal prostatic urethra. It was concluded that prostatic tissue Ablation in the canine model can be achieved safely and could justify the start of human trials.
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Transurethral Needle Ablation tuna thermal gradient mapping and comparison of lesion size in a tissue model and in patients with benign prostatic hyperplasia
European Urology, 1993Co-Authors: J S Rasor, Alexandre R. Zlotta, S D Edwards, Claude SchulmanAbstract:: A new device has been development for treating benign prostatic hyperplasia (BPH) that is performed as an outpatient procedure. the device (Transurethral Needle Ablation or TUNA) employs Needles that deliver low-level radiofrequency (RF) power locally at high temperature to ablate hyperplastic prostate tissue. During the TUNA procedure the temperature proximal to the Needle tips is measured with thermocouples within the Needle's protective shields and urethral temperature is measured via a thermocouple contained within the catheter tip. Tissue impedance is also measured by the TUNA catheter since it is well known from other thermal treatment methods that thermal destruction of prostatic tissue depends upon a particular prostate's tissue composition and thermoregulation. Because of this variation in prostates, a nomogram guide for setting the TUNA device was created using a turkey breast tissue model. Lesion sizes created at particular settings in the turkey breast model were similar to those created at the same settings in patients with BPH. In addition, local thermal gradients within the TUNA lesions were visualized and mapped using an infrared thermal imaging system which demonstrated that central lesion temperature with the device is approximately 80-100 degrees C.
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Transurethral Needle Ablation tuna safety feasibility and tolerance of a new office procedure for treatment of benign prostatic hyperplasia
European Urology, 1993Co-Authors: Claude Schulman, Alexandre R. Zlotta, Jean Christophe Noel, Luc Hourriez, J S Rasor, S D EdwardsAbstract:: Many attempts have been made to develop a method for treating benign prostatic hyperplasia (BPH) that is minimally invasive, efficacious, and low cost. The Transurethral Needle Ablation (TUNA) device has recently been developed to treat BPH by selectively ablating hyperplastic prostatic tissue. A special catheter incorporates Needles that deliver low-level radiofrequency power directly to a very localized area of the prostate. The Needles have adjustable shields to protect the urethra if desired or necessary. It is positioned via transrectal ultrasound or direct vision. A pilot study was performed in patients to evaluate TUNA feasibility via histopathological measurement of thermal lesion size and TUNA safety by: (1) monitoring urethral and rectal temperatures; (2) assessing the ability to localize lesions, and (3) determining patient tolerance of the procedure without anesthesia. Twenty patients were treated using TUNA prior to scheduled retropubic prostatectomy. The surgical prostatic specimens were recovered from 1 day to 1 month after TUNA, were step-sectioned, and examined histologically. Patients were 68 years old on average with prostate weight varying from 14 to 88 g. The TUNA procedure averaged 27 min, 4 lesion treatments per prostate, and 4-15 W of power applied for 3 min. Proximal lesion temperature was about 40-50 degrees C with central lesion temperatures of about 80-100 degrees C. Urethral temperature averaged 37-42 degrees C and rectal temperature remained unchanged. Macroscopic examination of the specimens demonstrated localized lesions averaging 12 x 7 mm. Microscopic examination showed larger lesions of extensive coagulative necrosis averaging 30 x 15 mm. Specific immunohistochemical staining showed destruction of all tissue components.(ABSTRACT TRUNCATED AT 250 WORDS)
