Durability and Cost-Effectiveness of Transurethral Needle Ablation of the Prostate as an Alternative to Transurethral Resection of the Prostate When α-Adrenergic Antagonist Therapy Fails

Purpose

We analyzed the adverse event profile, long-term efficacy and cost-effectiveness of transurethral needle ablation of the prostate for lower urinary tract symptoms associated with benign prostatic hyperplasia as an alternative to transurethral resection of the prostate in men with symptoms uncontrolled by medical therapy.

Materials and Methods

A total of 71 men on a waiting list for transurethral resection of the prostate after failed medical therapy underwent transurethral needle ablation of the prostate. Symptom scores, uroflowmetry and residual urine were measured before and up to 10 years following treatment. Transrectal ultrasound and pressure flow studies were performed before, and 3 and 12 months following treatment, respectively. Treatment failure was defined as lower urinary tract symptoms progression requiring further therapy or associated with deteriorating quality of life assessment.

Results

Apart from transient postoperative urinary retention, no significant treatment emergent adverse events due to transurethral needle ablation of the prostate were observed. Treatment failure occurred in 58 men (83%) at a median of 20 months. A total of 36 men (51%) underwent invasive treatment (transurethral resection of the prostate 33, bladder neck incision 2, microwave thermal ablation 1), 2 men (3%) were deemed unfit for anesthesia and now practice clean intermittent self-catheterization, 14 men (20%) reported improvement following resumption of treatment with an α-adrenergic antagonist after transurethral needle ablation of the prostate and 6 men (9%) have experienced deterioration in lower urinary tract symptoms with reduction in quality of life assessment (International Prostate Symptom Score 3 or greater) but have declined further intervention. There were 12 men (17%) who remained symptom-free up to 10 years after transurethral needle ablation of the prostate. The estimated additional cost of treatment for lower urinary tract symptoms per man treated with transurethral needle ablation of the prostate during the 10-year followup was $1,377.

Conclusions

Despite documented safety and lack of morbidity, the high re-treatment rate associated with transurethral needle ablation of the prostate renders it relatively expensive when viewed as a long-term alternative to transurethral resection of the prostate for the management of lower urinary tract symptoms associated with benign prostatic hyperplasia in men in whom medical therapy failed. Of men failing α-blockade therapy 20% will benefit from a combination of transurethral needle ablation of the prostate and α-blockade.

Key Words: prostatic hyperplasia, surgical procedures, minimally invasive, health expenditures, urinary tract, urodynamics

Abbreviations and Acronyms: AUA, American Urological Association, I-PSS, International Prostate Symptom Score, LUTS/BPH, lower urinary tract symptoms associated with benign prostatic hyperplasia, MIST, minimally invasive surgical therapy, pdetQmax, detrusor pressure at peak flow rate, QLA, quality of life assessment, Qmax, peak flow rate, TUNA, transurethral needle ablation, TURP, transurethral resection of the prostate