Transurethral needle ablation of the prostate (TUNA) uses the heat generated from radiofrequency (RF) energy to treat BPH. During the procedure, a specialized scope is inserted into the urethra, which allows the precise placement of two small needles into the prostate. The needles contain electrodes that are used to apply radiofrequency energy directly to the hyperplastic obstructing tissue. These unique needles have adjustable shields, which protect the urethra from thermal damage. This RF energy heats precise areas in the prostate to 70100°C, which ablates tissue and seals blood vessels.
Clinical studies show that TUNA reduces BPH symptoms and causes fewer side effects than surgical treatment. Healthy prostate tissue and urethral tissue is unaffected by treatment and clinical trials indicate that the procedure does not usually cause incontinence or impotence.
Transurethral needle ablation of the prostate may be indicated for patients with the following symptoms:
- Maximum uroflow rate < 15 mL/second and voided volume >125 mL
- Negative prostate biopsy
- Normal PSA levels
- Postvoid residual volume < 200 mL
- Urinary retention
The procedure is contraindicated in patients with any of the following:
- Active urinary tract infection
- Bladder neck contracture
- Impaired renal function
- Large median prostate lobe
- Neurological disease that impairs bladder function
- Radiofrequency-sensitive implants
- Previous prostate surgery
- Prostate > 100 g
- Urethral stricture
TUNA usually takes about 3060 minutes, depending on the size of the prostate, and is performed on an outpatient basis usually only requiring regional anesthesia. Depending on the size of the prostate, the procedure may be repeated in more than one area of the gland during the treatment session.
After treatment, approximately 40% of patients require catheterization for 13 days and antibiotics are prescribed for 35 days after removal of the catheter. Minimal discomfort can be treated using over-the-counter pain relievers. Possible complications include the following:
- Erectile dysfunction (rare)
- Irritative voiding symptoms
- Macroscopic hematuria
- Urethral stricture (rare)
- Urinary retention (may require recatheterization)
- Slight decrease in ejaculate
Following TUNA, most patients can return to normal activities in 23 days and experience an improvement in symptoms 26 weeks. Usually, symptoms continue to improve gradually over 23 months. Overall improvement of symptoms after 3 years is about 66 percent. In contrast to other modalities, studies have shown that men treated with TUNA only very rarely experience any ejaculatory dysfunction.