Day-case Local Anaesthetic Radiofrequency Thermal Ablation of Benign Prostatic Hyperplasia: A Four-year Follow-up

Abstract

Objective: This study reports long-term (median 4 years) clinical effectiveness, safety and patient acceptance of transurethral ablation prostatectomy (TURAPY) for symptomatic benign prostatic enlargement (BPE) using a radiofrequency technique. Material and methods: 25 men were treated as day-case procedures under local anaesthesia for 1 h. The age range was 55-88 years (mean age 65.5 years) and all were suffering from symptomatic BPE with urinary flow rates of 12 ml/s or less. The treatment was carried out with a computer-based device using a special heating element mounted on a Foley-like catheter for prostatic ablation and the temperatures were monitored continuously in the prostatic region, sphincteric area and rectum for safety purposes. Results: TURAPY was carried out in all patients with temperatures ranging from 70 to 82°C depending on the tolerance of the patient. The post-treatment mortality was nil and only 19 patients complained of mild dysuria, passing of some debris and/or minor bleeding on voiding which settled spontaneously in 2-3 weeks, except in two patients who had proven urinary infection requiring antibiotic therapy. At 4 years the International Prostate Symptom Score (I-PSS) improved from a mean value of 16.0 to 7.2 (p < 0.01) with quality-of-life score falling from 4 to 1.9 (p < 0.05); mean flow rate increased from 8.5 to 11.7 ml/s and mean residual volume decreased from 185.04 to 52.8 ml (p < 0.05). Post-treatment pressure flow studies in 14 patients showed normal pressure voiding in one, with four being in an equivocal range, but the rest were obstructed. Prostate ultrasound scanning before and after treatment in 15 patients showed a mean reduction of volume of 16.7 ml suggesting cavitation of prostate following TURAPY. Conclusions: TURAPY provides lasting subjective but modest objective benefits in symptomatic BPE patients. It is worthy of consideration in elderly patients, or in those who are unfit for surgery or who do not wish to undergo surgery. It is a safe procedure with little transient morbidity but no mortality.