Authors' objectives:

The aim of this report is to evaluate the efficacy, safety and cost-effectiveness of TUNA in the treatment of symptomatic BPH considering the scientific evidence available.

Authors' results and conclusions: 35 articles were identified and analysed (4 RCTs, 4 comparative non-randomized studies and 26 clinical series). Although evidence was limited by methodological issues, the analysis of relevant outcomes indicates that while TUNA significantly improves BPH parameters with respect to baseline, it does not reach the same level of efficacy as Transurethral Resection of Prostate (TURP) in respect to all subjective and objective variables. Further, its efficacy declines in the long-term with a rate of secondary-treatment significantly higher than of TURP [OR: 7.44 (2.47, 22.43)]. Conversely, TUNA seems to be a relatively safe technique and shows a lower rate of complications than TURP [OR: 0.14 (0.05, 0.14)] with differences being particularly noteworthy in terms of postoperative bleeding and sexual disorders. Likewise, TUNA is a well tolerated procedure, has fewer anesthetic requirements and generates a shorter hospital stay than TURP [WMD: -1.9 (-2.75, -1.05)]. Poor quality, scarce data and lack of replication of comparisons hinder the assessment of TUNA vs. other therapies.

Authors' recommendations: This report identified a body of comparative and non-comparative studies indicating that TUNA is a relatively safe and promising technique that may eventually prove to have a role in selected patients with symptomatic BPH. Current evidence shows that the usefulness of TUNA in symptomatic BPH must balance its advantages in terms of morbidity, anesthetic requirements and hospital stay against the fact that it does not reach the same level of efficacy and longlasting success as TURP and the increased risk of secondary-treatment. In addition, the review of the literature highlights the existence of a number of areas of uncertainty, chief among which, in our opinion, are: the precise mechanism of action of the technique and the factors implicated in the treatment's success; the lack of comparative studies with respect to medical treatment; the position of TUNA with respect to other minimally invasive therapies; and the cost-effectiveness ratio of the technique. Such data would be of critical importance if the real role of TUNA in the treatment of symptomatic BPH is to be defined with any degree of certainty.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.isciii.es/aets/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Evaluacion de Tecnologias Sanitarias

Contact Address: Instituto de Salud "Carlos III", Calle Sinesio Delgado 6, Pabellon 4, 28029 Madrid, Spain. Tel: +34 9 1 822 2005; Fax: +34 9 1 387 7841;

Contact Name: Luis M. Sánchez Gómez

Contact Email: luism.sanchez@isciii.es

Copyright: Agencia de Evaluacion de Tecnologias Sanitarias (AETS)