Tuna Versus Turp - Newer Treatments For Benign Prostatic Hyperplasia.
[17-09-1999]

By: Dr. Diamond Alidina

With rapid improvements and innovations in medical technology, treatment choices in many areas of medicine have undergone major changes. Doctors and patients are now faced with a dizzying array of choices when considering options for treatment of their illnesses. One such area is the treatment of benign prostatic hyperplasia(BPH).

BPH is a very common benign condition affecting at least 50% of men over 50. The major and sometimes only symptom is difficulty with passing urine. While some men regard this as an aging process, for many, this is an agonizing and frustrating experience.

	Poor flow of urine.
	Difficulty in starting to pass urine.
	Frequent urination.
	Waking up at night a number of times to pass urine.
	Difficult or painful urination.
	Dribbling urination.
	Incontinence.
	Blood or pus in urine.

Other conditions may result in similar symptoms, and must be ruled out by appropriate testing.

Once a diagnosis of BPH has been established, a variety of treatment options may be considered depending on the severity of the symptoms. Various symptom scores have been devised to assess the severity of the condition.

The available treatments are medical (non-surgical), and surgery.

Medical and herbal treatments include saw palmetto and pygeum, both herbals which, have been shown to shrink the prostate, as well as prescription medications such as finasteride, terazocin, doxazocin, and tamsulosin. These prescription medications may cause low blood pressure and lethargy.

The traditional surgical treatment is a trans-urethral resection of the prostate, or "TURP". Other available treatments include laser TURP, vaportrode, TIOP (trans-urethral incision of the prostate), balloon dilatation of the prostate, and prostate stents. All these procedures are effective in good hands, but require general or spinal anesthesia. Anesthesia may cause problems in older men, or in patients taking multiple medications, or with severe cardiac problems.

As BPH is a disease of older men, the need for less invasive alternatives to TURP has led to the development of minimally invasive thermal therapies, with much less risk and less potential for the low blood pressures associated with the conventional surgical therapies.

These newer and less invasive therapies utilize laser, radio frequency, microwaves, and ultrasound. The most promising and effective of these at this time is called tuna, or trans-urethral needle ablation, which utilizes radio frequency to heat and selectively destroy the excess prostatic tissue. This procedure is done on an outpatient basis, using local anaesthetic, and represents a major improvement over the conventional surgical treatments.

Tuna is currently FDA approved, and covered by Medicare in 29 states. In Canada, TUNA is not covered by provincial health plans.

Based on results so far, TUNA is an effective alternative to standard surgery, and is also associated with significantly lower risks. This results in a better quality of life.

Long term studies are awaited, but the lack of significant risks, particularly incontinence and sexual dysfunction, make this a more acceptable treatment .

So, if you were a male with bph and requiring surgery, which would you rather choose - tuna or turp?

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