Transurethral needle ablation

Transurethral needle ablation (TUNA), also called radiofrequency therapy, is an outpatient procedure that uses radio waves to heat and destroy the part of your prostate that's blocking urine flow. During this procedure, a cystoscope is passed into the urethra and needles are placed in the prostate gland under visual guidance. Radio waves pass through the needles and heat the prostate and destroy the blockage.

What to expect. TUNA requires more pain control and sedation than does TUMT, so you'll likely be given intravenous sedation. In some cases, spinal or general anesthetics are used. The procedure takes about 30 to 45 minutes. You can go home as soon as you have urinated without a catheter. Some men require a catheter for a few days after the procedure. You'll take antibiotics to prevent infection and nonsteroidal anti-inflammatory medication to reduce pain for several days after the procedure. Most men resume routine activities and sexual functioning in a week or two.

Who it works best for. TUNA works best for men who have mild to moderate obstruction of the urethra, not caused by enlargement of the prostate's middle lobe — the upper part that rests against the bladder. It doesn't work well for men with very large prostates.

Outcome. TUNA relieves symptoms more effectively than medications do, but less effectively than traditional prostate surgery (TURP) does. TUNA reduces symptom scores by an average of nine points.

Side effects. It's not unusual to have blood in your urine for several days after the procedure. TUNA side effects can be more serious than medication side effects are, but less serious than TURP side effects. Painful urination or the need for a catheter after surgery is the most common complication.

Other side effects:

• Temporary urine retention can last for up to a few weeks and may require a catheter.
• Symptoms such as urgent or frequent need to urinate occur temporarily in about one in 10 men.
• Urinary tract infection occurs in some men — most often in those who must use a catheter for an extended period.
• Permanent narrowing (stricture) of the urethra and retrograde ejaculation are rare complications.

Need for re-treatment. Within a few years after treatment, TUNA stops working for some men. Your doctor may then recommend surgery.