【摘要翻译】TUNA和TURP治疗有症状的BPH：5年前瞻、随机、多中心临床研究的结果

[文题]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.
TUNA和TURP治疗有症状的BPH：5年前瞻、随机、多中心临床研究的结果
[来源]Journal of Urology.
[年、卷、期、页]2004. 171(6, Part 1 of 2):2336-2340
[作者]HILL, BRIAN; BELVILLE, WILLIAM; BRUSKEWITZ, REGINALD; ISSA, MUTA; PEREZ-MARRERO, RAMON; ROEHRBORN, CLAUS; TERRIS, MARTHA; NASLUND, MICHAEL
[原文摘要]
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.
[中文译文]
目的：我们报告比较经尿道针刺消融（TUNA）和经尿道前列腺切除（TURP）治疗继发于良性前列腺增生（BPH）的下尿路症状（LUTS）的5年的有效性和安全性。
材料与方法：来自美国7个医疗中心共121例50岁以上患者参与本前瞻的随机临床研究，患者均为继发于BPH的LUTS，病程至少3月。患者随机分组接受TUNA（65例，54%）或者TURP（56例，46%）治疗。术前及术后每年评估IPSS、生活质量、最大尿流率、残余尿及前列腺体积和外形，共持续5年，同时记录并发症。
结果：TUNA和TURP两组术后每次访问时的IPSS、生活质量和最大尿流率较术前的改善均有统计学意义。TURP组术后每次访问时的残余尿较术前均有统计学意义，而TUNA组在术后5年时残余尿较术前有统计学意义。TURP组报告41%逆向射精而TUNA组无。TURP组ED、尿失禁和尿道狭窄发生率均高于TUNA组，后者并发症明显少于前者。
结论：此研究结果显示TUNA在5年后具有稳定的治疗效果，提示TUNA对于继发于BPH的LUTS是一个具有吸引力的治疗选择。
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[个人评论]随机对照多中心的研究结果令人信服，不知国内TUNA的应用现状如何，期待有经验者指教。