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The influence of 3-dimensional prostate gland reconstruction on results of transurethral needle ablation of the prostate (TUNA) in patients with benign prostatic hyperplasia
Article published in Urologia Polska 2003/56/1.


Grzegorz Kata 1, Artur A. Antoniewicz 1, Piotr Chłosta 2, Tomasz Szopiński 1, Andrzej Borówka 1
1 Zespół Dydaktyki Urologicznej Centrum Medycznego Kształcenia Podyplomowego Oddział Urologii Centralnego Szpitala Kolejowego w Warszawie
Kierownik zespołu i ordynator oddziału: prof, dr hab. Andrzej Borówka
2 Oddział Urologii Szpitala Kolejowego we Wrocławiu


prostate, benign prostatic hyperplasia, transurethral needle ablation, transrectal ultrasonography, modeling of prostate


Introduction. Transurethral needle ablation (TUNA) is one ol\'the minimal invasive methods ol\'treatmenl of benign prostatic hyperplasia (BPI 1). The principle of this method is to develop necrotic lesions in the prostatic gland by means of the hot action of wave-lengths locally emitted by transducers inserted into lateral lobes of the prostate under urethroscopic control. During a typical operation, the transducer is inserted into defined areas, mid the number of insertions depends on the length of the gland. However, in the BPH process the spatial shape of the gland may be different in individual patients. It seems that the preoperative estimation of this shape by transrectal ultrasonography (TRUS) may be helpful in deciding the depth and direction of transducer insertions.
The aim of the study. The aim of this study was to define an influence of prostate spatial shape, estimated by virtual 5-dimensional (3D) TRUS reconstruction, on the efficacy and safely of TUNA.
Material and method. The whole group consisted of 22 patients, aged from 51 to 70 years (mean 66 years), with relative indications to surgical treatment of BPH. Patients were randomized into two groups. In patients of group A (n = 11) 3D TRUS-guided reconstruction of the gland was done before TUNA, according to our own method. Transducers insertions were related of the prostatic shape. Patients of the group B (n = 11) underwent standard TUNA, preceded by conventional TRUS examination.
In both groups, the results of TUNA were estimated regarding of following factors: intensity of lower urinary trad symptoms (LUTS), quality of life (QoL) defined on the basis of 1-PSS questionnaire, maximal urethral flow value (Qmax). residual volume (Rv). quality of sexual life (in sexually active men) defined on the basis of IlliF-5 questionnaire, as well as prostate volume (Pv). All these factors were estimated before treatment and 14. 30 and 60 days after Tl INA.
Results. In 9 patients of group A spatial shape ol\'the prostate, estimated by 3D TRUS-guided reconstruct ion. modified mode of transducer insertions into the lateral lobes of the gland (e. g. depth and inclination in relation to prostatic urethra axis). The mean operation time was 1 7.3 min longer in this group than in group B (4 3.3 min). Complete urinary retention after bladder catheter removal was observed in 4 patients of group A mid in 3 patients of group B. Two months .liter TI
Conclusions. The use of 3D TRUS-guided computer prostate reconstruction before operation does not influence TUNA efficacy and safety. TUNA is a safe, minimally invasive method of surgical treatment of BPH. Short-term results of TUNA are satisfactory.


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Sławomir Grzegorz Kata
Oddział Urologii
Centralnego Szpitala Kolejowego w Międzylesiu
ul. Bursztynowa 2
04-749 Warszawa
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