Boyle Peter, Robertson Christopher, Vaughan E Darracott, Fitzpatrick John M
Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
BJU Int. 2004 Jul;94(1):83-8. doi: 10.1111/j.1464-410X.2004.04906.x.
To investigate the short- and long-term effectiveness of transurethral needle ablation (TUNA) of the prostate for clinical benign prostatic hyperplasia (BPH), using a meta-analysis of all clinical studies involving TUNA.
Data were extracted from two randomized trials, two non-randomized observational protocols and 10 single-arm studies conducted on TUNA, according to a determined protocol. The meta-analysis was based on the change in the mean score at the end of study from that at baseline. The estimation of the effects from the meta-analysis used a multilevel model including random effects for the studies.
In all studies the patients recruited had severe lower urinary tract symptoms and a mean International Prostate Symptom Score (IPSS) of > 20 before treatment. The effect of TUNA was to halve the mean IPSS at 1 year after treatment and, although there was a slight tendency for the IPSS to increase in all arms from year 1 to year 5, this decrease by half was maintained at 5 years. The maximum urinary flow rate (Q(max)) also increased by approximately 70% from baseline to 1 year and in virtually all studies the mean Q(max) approached or exceeded 15 mL/s. Although there was a tendency for Q(max) to decline slightly over time, the mean Q(max) 5 years after treatment was > 50% over baseline.
This meta-analysis shows that TUNA is an effective and minimally invasive treatment for men with clinical BPH, even when the symptoms are severe. There is a significant improvement in symptoms and flow rate after 1 year which persists for at least 5 years. TUNA therapy would appear to be an alternative to surgery and an attractive option for men who do not wish to undergo long-term medical therapy, are poor candidates for surgery or are concerned about the side-effects of TURP.
通过对所有涉及经尿道针刺消融术（TUNA）治疗临床良性前列腺增生（BPH）的临床研究进行荟萃分析，探讨TUNA治疗BPH的短期和长期疗效。
根据既定方案，从两项随机试验、两项非随机观察性方案以及10项关于TUNA的单臂研究中提取数据。荟萃分析基于研究结束时的平均得分与基线时的平均得分的变化。荟萃分析的效应估计使用了一个多水平模型，该模型包括研究的随机效应。
在所有研究中，招募的患者均有严重的下尿路症状，治疗前平均国际前列腺症状评分（IPSS）>20。TUNA的效果是在治疗后1年将平均IPSS减半，尽管从第1年到第5年所有组的IPSS均有轻微上升趋势，但这种减半的效果在5年时仍得以维持。最大尿流率（Q(max)）从基线到1年也增加了约70%，并且在几乎所有研究中，平均Q(max)接近或超过15 mL/s。尽管Q(max)有随时间略有下降的趋势，但治疗后5年的平均Q(max)仍比基线高>50%。
这项荟萃分析表明，TUNA对于患有临床BPH的男性是一种有效且微创的治疗方法，即使症状严重时也是如此。治疗后1年症状和尿流率有显著改善，且至少持续5年。TUNA疗法似乎是手术的一种替代方法，对于那些不希望接受长期药物治疗、手术条件不佳或担心经尿道前列腺切除术（TURP）副作用的男性来说是一个有吸引力的选择。
