Transurethral needle ablation (TUNA)

Overview

Transurethral needle ablation (TUNA) — also known as radiofrequency ablation — is an outpatient procedure to treat urinary symptoms caused by an enlarged prostate.

A combined visual and surgical instrument (cystoscope) is inserted through the tip of your penis into the tube that carries urine from your bladder (urethra). The prostate surrounds the urethra. Using the cystoscope, your doctor guides a pair of tiny needles into the prostate tissue that is pressing on the urethra.

Radio waves are then passed through the needles, generating heat that creates scar tissue. Special shields protect the urethra from the heat. The scarring shrinks prostate tissue, allowing urine to flow more easily.

TUNA is one of several minimally invasive treatment options for an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH). To determine the right 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.

Why it's done

TUNA helps reduce urinary symptoms caused by BPH, including:

• Frequent, urgent need to urinate
• Difficulty starting urination
• Slow (prolonged) urination
• Increased frequency of urination at night
• Stopping and starting again while urinating
• The feeling you can't completely empty your bladder
• Urinary tract infections

TUNA might also be done to treat or prevent complications due to blocked urine flow, such as:

• Recurring urinary tract infections
• Kidney or bladder damage
• Inability to control urination or an inability to urinate at all
• Bladder stones
• Blood in your urine

TUNA can offer several advantages over other methods of treating BPH, such as transurethral resection of the prostate (TURP) and open prostatectomy. Possible advantages include:

• 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.

Risks

TUNA is generally safe with few if any major complications. Possible risks of TUNA include:

• New onset or worsening urinary symptoms. Sometimes TUNA can result in a chronic inflammation within the prostate. The inflammation can cause symptoms including a frequent or urgent need to urinate, and painful urination.
• Temporary difficulty urinating. You might have trouble urinating for a few days after the procedure. Until you can urinate on your own, you will need to have a tube (catheter) inserted into your penis to carry urine out of your bladder.
• 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. You will likely need antibiotics to treat the infection.
• 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. You might need to be treated again with TUNA or another BPH therapy.

How you prepare

Food and medications

Several days before surgery, your doctor might recommend that you stop taking medications that increase your risk of bleeding, such as:

• Blood thinners such as warfarin (Coumadin) or clopidogrel (Plavix)
• Nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others)

Your doctor will likely prescribe an antibiotic to prevent a urinary tract infection.

Other precautions

You won't be able to drive yourself home after the procedure that day or generally if you have a catheter in your bladder. Arrange for someone to take you home.

You might not be able to work or do strenuous activity for two to three days after surgery. Ask your doctor how much recovery time you might need.

What you can expect

You'll be given a local anesthetic to numb the prostate area. The anesthetic might 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.

You might also have intravenous (IV) sedation. With IV sedation, you'll be drowsy but remain conscious during the procedure.

During the procedure

Using the scope, your doctor will insert small needles into your prostate. You might feel a little pain or discomfort when the radio waves pass through the needles to heat and destroy prostate tissue.

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 likely need to take antibiotics to prevent a urinary tract infection.

You might notice:

• Blood in your urine. This shouldn't last for more than a few days.
• Irritating urinary symptoms. You might feel an urgent or frequent need to urinate, or you might have to get up more often during the night to urinate. Most men experience burning, especially at the tips of their penises and as they finish urinating. These symptoms generally last about a week.
• Difficulty holding urine. Incontinence can occur because your bladder is used to having to push urine through a urethra narrowed by enlarged prostate tissue. For most men, this issue improves with time.
• Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. The risk of infection increases the longer you have a catheter in place. Some men have recurring urinary tract infections after TUNA.

Results

It can take several weeks for you to see significant improvement in your urinary symptoms. That's because your body needs time to break down and absorb prostate tissue that has been destroyed. It can take a few months for some men to notice significant improvement.