Transurethral Needle Ablation (TUNA)

What is Transurethral Needle Ablation (TUNA)?

Transurethral needle ablation (TUNA) is a minimally invasive medical treatment that utilizes radiofrequency energy to treat an enlarged prostate gland.

Enlarged prostate, also known as benign prostatic hyperplasia or BPH, is the most common prostate problem in men. Almost all men develop some degree of prostate enlargement as they age. The prostate is a small, walnut-sized gland situated between the bladder and the penis, just in front of the rectum. The prostate gland encircles the urethra (the tube through which urine passes from your bladder and your body). When the gland enlarges, it presses against the urethra, restricting urine flow through the tube and causing problems with urination and other associated symptoms. The exact cause of prostate enlargement is unknown. However, it is believed that factors connected to aging and changes in the cells of the testes may play a part in the enlargement of the gland, in addition to testosterone levels. Also, a family history of prostate issues or any abnormalities with your testes may increase your risk of prostate enlargement.

During the TUNA procedure, radiofrequency needles are inserted through the urethra into the region of the prostate that is pressing on the urethra. Radio waves are then passed through the needles into the prostate tissue to ablate (destroy) the superfluous prostate tissue. Consequently, the prostate shrinks, which enables urine to flow out of the urethra.

Indications for Transurethral Needle Ablation (TUNA)

Your physician may recommend transurethral needle ablation (TUNA) when medication and other nonsurgical treatments have not been able to effectively treat prostate enlargement and its associated symptoms, such as:

• Urinary frequency (frequent urination)
• Urinary hesitancy (straining to urinate)
• Urinary urgency (Strong and sudden urge to urinate)
• Urinary retention (inability to urinate)
• Hematuria (blood in the urine)
• Dysuria (pain with urination)
• Incomplete bladder emptying
• Dribbling at the end of urination
• Delayed or slowed start to urination
• Weak urine stream

Preparation for Transurethral Needle Ablation (TUNA)

Pre-procedure preparation for transurethral needle ablation (TUNA) may involve the following steps:

• A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to the procedure.
• Diagnostic tests such as bloodwork and flow rate bladder scan to see how well the patient is emptying, and a prostate ultrasound to evaluate prostate condition
• You should inform your doctor about:
  • Your current medication list
  • Supplements or herbal products you are taking
  • Allergies to any food or medications
  • Any conditions you have such as heart or lung disease
• You may be asked to refrain from certain medications such as blood thinners or vitamin/herbal supplements for a week or two prior to the procedure.
• You are advised to avoid smoking before and after the procedure for a defined period of time as smokers may have more breathing problems during the procedure and heal more slowly.
• Arrange for someone to drive you home after the procedure.
• You are advised not to eat or drink at least 6 hours prior to the procedure.
• An informed consent form will be obtained from you after the pros and cons of the procedure have been explained.

Procedure for Transurethral Needle Ablation (TUNA)

The transurethral needle ablation (TUNA) procedure is typically performed in your urologist’s office under local anesthesia to numb your penis and urethra. During the procedure, a cystoscope - a tiny, lighted, tubular instrument with a camera - along with needle electrodes are inserted through the penis into the prostate. The scope allows your physician to see the region where the enlarged prostate is causing problems with passing urine. High-frequency radio waves are then sent through the needles into various regions of the prostate gland to destroy excess prostate cells. Your urologist will determine how many needles need to be placed into the prostate and how long each one will be placed at each location based on the size and shape of the prostate. Usually, 4 to 6 needles are used and are held at each location for as long as three minutes. Once satisfactory treatment is achieved, a catheter is inserted into the penis for some days until the urethra is healed and you can urinate on your own.

Post-Procedure Care and Recovery

In general, post-procedure care and recovery after transurethral needle ablation (TUNA) include:

• You will be transferred to the recovery room for observation. You should be able to go home on the same day as your procedure.
• You may experience mild to moderate pain. Medications will be provided as needed to address these.
• Antibiotics may also be provided for the risk of urinary tract infections.
• Discomfort during urination, burning sensation, and blood in the urine are common for the first few days after the procedure.
• You are advised to drink plenty of water, at least 2 liters a day.
• As the effects of anesthesia can take about 24 hours to wear off, you are advised not to drive or operate any machinery during this period.
• You may resume your normal daily activities the next day. However, you should avoid any strenuous exercises or activities or lifting anything heavier than 10 pounds for at least a week.
• You may need to wear the catheter for up to a week. The catheter will be removed during your follow-up and you should be able to pass urine normally thereafter. Avoid sex for at least 2 to 3 weeks.
• Follow-up appointments will be scheduled to monitor your progress.

Risks and Complications

All treatments have inherent and associated risks. Potential risks and complications of transurethral needle ablation (TUNA) include:

• Swelling
• Bleeding or blood in urine
• Urinary tract infections
• Worsening urinary problems
• Obstruction
• Injury to surrounding tissues
• Adverse reactions to anesthesia