The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on transurethral radiofrequency needle ablation of the prostate in October 2003.
This guidance has been withdrawn as the use of this procedure is now covered in the clinical guideline on the management of lower urinary tract symptoms in men published in May 2010, www.nice.org.uk/cg97. NICE has no plans to carry out further assessment of this procedure under the Interventional Procedures Programme.
This procedure is used to treat benign prostatic obstruction (BPO). BPO is a non-malignant enlargement of the prostate and is a common cause of lower urinary tract symptoms in men older than 40 years of age,
BPO can be managed medically or surgically. The standard surgical treatment is transurethral resection of the prostate. However, relatively high morbidity for this procedure has led to the development of a range of minimally invasive techniques, some of which utilise thermal energy.
Transurethral radiofrequency needle ablation of the prostate is one such procedure. It uses radiofrequency energy delivered to the prostate via needle electrodes. Transurethral radiofrequency needle ablation of the prostate is indicated in patients with moderate to severe bladder outlet obstruction and smaller prostates (up to 75 ml).
Low levels of radiofrequency energy are delivered to the prostate via two needle electrodes which are positioned using a catheter transurethrally under direct vision. Energy passes between the two electrodes causing prostate tissue heating and leading to ablation of prostatic tissue through coagulative necrosis. Thermal shields protect the urethra from thermal damage and ensures that the thermal lesion created remains localised.