Transurethral needle ablation (TUNA) is a minimally invasive, office based procedure used to treat BPH. The indications for treatment are similar to other BPH treatments and typically are reserved for symptom progression or intolerance of medication side effects.
Transurethral needle ablation (TUNA) of the prostate is a procedure used to treat benign prostatic hyperplasia (BPH). It is performed by placing interstitial radiofrequency (RF) needles through the urethra and into the lateral lobes of the prostate, causing heat-induced coagulation necrosis.
When being treated with TUNA for BPH, the patient lies on a table with his legs up in stirrups. A cytoscope is inserted through the penis into the prostate. A specially designed catheter is then inserted through the cytoscope into the urethra. A needle is connected to the end of this instrument. The needle uses high temperature heat from low level radio waves. It is pushed into different locations around the prostate gland to kill the excess cells.
The needle is held from one and a half to three minutes at each location where it is placed. The number of needles used is determined by the size and shape of the prostate. The average procedure uses four to six needles.
A catheter is placed and the patient is discharged home.
After the Procedure
You will likely have a urinary catheter in place because of swelling that blocks urine flow. The catheter is generally removed after one to three days. You will typically have burning with urination after the catheter is removed. This lasts typically for 2-3 weeks.
Recovery times after a transurethral needle ablation will vary based on the patient, however most can expect to return to normal activities within a few days after the procedure.
The prostate will heal over time and the urinary obstruction will be reduced. The benefits of a TUNA treatment will usually be obvious within eight to ten weeks, at which point the symptoms of BPH should start to improve. During this time, the patient should see a steady improvement in symptoms. Irritative symptoms such as frequency and urgency can take up to 3 months to improve.
- It does not require general anesthesia which is appealing for patients with several medical problems.
- Should be able to stop taking medication and still have an improvement in urination.
- Lower risk of bleeding. TUNA can be a good option for men who take medication to thin their blood or who have a bleeding disorder that doesn’t allow their blood to clot normally.
- No hospital stay. TUNA can be done on an outpatient basis and might be a safer option than surgery if you have certain other health problems.
- When compared against transurethral resection of the prostate (TURP), TUNA for BPH has several benefits. Research shows that patients who underwent TUNA had fewer complications with postoperative bleeding and sexual disorders.
- Patients typically do not need hospitalization.
- TUNA requires less anesthesia and can be done in a physician’s office.
- When compared with TURP, TUNA for BPH has a higher failure rate and more frequent need for additional treatment. 25% at 5 years.
- In cases where TUNA doesn’t provide sufficient symptom relief, patients may have to undergo one of the more extensive procedures at a later date.
- New or worsening urinary symptoms. Sometimes TUNA can result in a chronic inflammation within the prostate resulting in irritative symptoms.
- Urinary retention. You might have trouble urinating for a few days after the procedure during which time a catheter will be needed.
- Urinary tract infection. This type of infection is a possible complication after any prostate procedure. An infection is increasingly likely to occur the longer you have a catheter in place.
- Erectile dysfunction. The risk of erectile dysfunction after prostate treatments is small and generally lower with TUNA than with traditional surgery.
- Need for retreatment. TUNA might be less effective in treating urinary symptoms than other minimally invasive treatments, or surgery. Approximately 25% of patients need retreatment at 5 years.
Since larger prostates require more treatment, TUNA for BPH is best for men whose prostates are not too large. The treatment is useful for prostates about 20 grams in size. It is not as effective for larger prostates.