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Transurethral needle ablation (TUNA)
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/tuna/MY00608
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Definition
Transurethral needle ablation (TUNA) is an outpatient procedure to treat urinary symptoms caused by an enlarged prostate. This procedure is also called radiofrequency ablation or RF therapy for enlarged prostate.
During TUNA, a specially adapted visual instrument (cystoscope) is inserted through the tip of your penis into the tube that carries urine from your bladder (urethra). Using the cystoscope, your doctor guides the placement of tiny needles into your prostate. Then radio waves are passed through the needles to create scar tissue. This scarring shrinks prostate tissue, opening up the urinary channel so urine can flow more easily.
TUNA is one of several options for treating an enlarged prostate, a condition also known as benign prostatic hyperplasia (BPH). To determine the best treatment choice for you, your doctor will consider how severe your symptoms are, what other health problems you have, and the size and shape of your prostate.
Before doing any enlarged prostate procedure, your doctor may want to do a test that uses a visual scope to look inside your urethra and bladder (cystoscopy). This allows the doctor to check the size of your prostate and examine your urinary system. Your doctor may also want to do other tests, such as blood tests or tests to measure urine flow.
Why it's done
TUNA is used to ease urinary symptoms and complications resulting from blocked urine flow, such as:
- A frequent, urgent need to urinate
- Difficulty starting urination
- Slow (prolonged) urination
- Increased frequency of urination at night (nocturia)
- Stopping and starting again while urinating
- The feeling you can't completely empty your bladder
- Urinary tract infections
Other enlarged prostate procedures include transurethral resection of the prostate (TURP), transurethral microwave therapy (TUMT), transurethral incision of the prostate (TUIP), laser surgery such as holmium laser enucleation of the prostate (HoLEP) or laser photovaporization of the prostate (PVP), and open prostatectomy.
In the long term, TUNA is less effective than is TURP or open prostatectomy. But, TUNA has several advantages over surgery:
- For most men, it's done without an overnight hospital stay (on an outpatient basis).
- It has lower risk factors for bleeding and other complications than does surgery.
- It may be a safer alternative if surgery isn't a good choice for you because of certain other health problems.
- It is less likely to cause difficulty holding urine (urinary incontinence) than is surgery.
Risks
Risks of TUNA include:
- Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An infection is increasingly likely to occur the longer you have a tube to drain urine (urinary catheter) in place after the procedure. It may require antibiotics or other treatment.
- Need for retreatment. Some men who have TUNA later require more treatment to ease urinary symptoms — usually surgery. Some men need further treatment because they develop long-term prostate irritation that can cause swelling and pain (chronic prostatitis).
How you prepare
Follow your doctor's instructions on what to do before your treatment. Here are some things that you may need to do:
- Ask about blood-thinning medications. Your surgeon may ask you to stop taking medications that increase your risk of bleeding several days prior to the procedure. These include warfarin (Coumadin), clopidogrel (Plavix), and nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Talk to the doctor who prescribed your medication before you make any changes.
- Don't eat before your procedure. Your doctor will likely ask you to not eat or drink anything after midnight. On the morning of your procedure, take only the medications your doctor tells you to with a small sip of water.
- Arrange a ride home. You won't be able to drive yourself home after the procedure. Ask your doctor ahead of time how long you can expect to be at the surgery center or hospital.
Your doctor may also give you other steps to follow.
What you can expect
TUNA takes less than an hour. It's usually done as an outpatient procedure, which means you will go home the day of the procedure.
You may be given an enema kit, which is used to clear your bowels and rectum at home, the morning of surgery. Shortly before your treatment, you will be asked to urinate so that your bladder is empty.
You'll be given a local anesthetic to numb the prostate area. The anesthetic may be inserted through the tip of your penis, or given in a shot via your rectum or in the area between your scrotum and anus (perineum).
You may also have intravenous (IV) sedation. With IV sedation, you'll be drowsy but remain conscious during the procedure. In some cases, spinal anesthesia or general anesthesia is used. With spinal anesthesia, you're numb from the waist down. With general anesthesia, you are unconscious during the procedure.
During the procedure
Once the anesthetic is working, a specially adapted visual instrument (cystoscope) is passed through the opening of your penis into your urethra. Your doctor will insert the cystoscope until it reaches the prostate area.
When the cystoscope is in place, your doctor will insert small needles into your prostate through the end of the cystoscope. Then, radio waves pass through them to heat and destroy prostate tissue blocking urine flow. You may feel a little pain or discomfort. The procedure generally takes about 45 minutes.
After the procedure
After TUNA, you'll have a catheter that extends through the tip of penis into your bladder. This allows you to pass urine until you can urinate on your own.
After the procedure, follow your doctor's instructions for recovery.
- Don't take blood-thinning medications until your doctor says it's OK.
- Don't do any strenuous activity, such as heavy lifting, for three to five days.
- Don't drive for the rest of the day after your procedure.
- Don't have sex until your doctor says it's OK. Most men can resume sexual activity after a few weeks.
Ask your doctor about any specific restrictions or other steps you need to take after the procedure. Your doctor may prescribe antibiotics to prevent infection and medications to reduce pain.
Side effects of TUNA can include:
- Blood in your urine (hematuria) for a few days after the procedure.
- Irritating urinary symptoms such as painful urination, difficulty urinating, or an urgent or frequent need to urinate. These symptoms usually improve within a week or so.
- Temporary difficulty urinating. A number of men have trouble urinating (urinary retention) after the procedure. If this happens, you may need to have a catheter in place for a few days. In some cases, a catheter is needed for a few weeks or longer.
- Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An infection is increasingly likely to occur the longer you have a catheter in place and may require antibiotics or other treatment. Some men have recurring urinary tract infections after TUNA.
Results
Several weeks may pass before you see a noticeable improvement in your urinary symptoms. It can take a few months for some men to notice significant improvement. That's because your body needs time to break down and absorb prostate tissue that has been destroyed.
Some men who have TUNA will eventually need additional procedures for enlarged prostate. More studies are needed to determine the overall, long-term effectiveness of TUNA compared with other procedures.
After TUNA, it's important to have a digital rectal exam once a year to check your prostate and screen for prostate cancer, as you would normally. If you notice any worsening urinary symptoms, make an appointment to see your doctor.
- Fitzpatrick JM, et al. Minimally invasive and endoscopic management of benign prostatic hyperplasia. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/125743340-3/0/1445/91.html?tocnode=54305416&fromURL=91.html. Accessed Jan. 27, 2011.
- Guideline on the management of benign prostatic hyperplasia (BPH). Linthicum, MD. American Urological Association. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bph. Accessed Jan. 27, 2011.
- d'Ancona FC. Nonablative minimally invasive thermal therapies in the treatment of symptomatic benign prostatic hyperplasia. Current Opinion in Urology. 2008;18:21.
- Han M. Transurethral needle ablation of the prostate. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-7216-0798-6..50090-X--cesec17&isbn=978-0-7216-0798-6&type=bookPage§ionEid=4-u1.0-B978-0-7216-0798-6..50090-X--cesec17&uniqId=239958488-4#4-u1.0-B978-0-7216-0798-6..50090-X--cesec17. Accessed Jan. 2, 2011.
- Cunningham GR, et al. Surgical and other invasive therapies of benign prostatic hyperplasia. http://www.uptodate.com/home/index.html. Accessed Jan. 2, 2011.
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