Transurethral Needle Ablation of the Prostate

What is transurethral needle ablation of the prostate (TUNA)?

Transurethral needle ablation of the prostate, or TUNA, is a treatment for an enlarged prostate gland. The prostate gland is part of a man's reproductive system. It is normally a little bigger than a walnut. It is located between the base of the bladder and the beginning of the penis. It surrounds the upper part of the urethra. (The urethra carries urine from the bladder out through the penis.) The prostate gland produces a fluid that is ejaculated with sperm.

For this procedure, the urologist (a surgeon who specializes in problems of the kidneys and bladder) uses high-frequency radio waves to destroy the part of the prostate gland that is causing the problem.

When is it used?

When the prostate gland is enlarged it is called benign prostate hyperplasia, or BPH. BPH is usually a harmless but annoying condition that causes men to have to urinate urine often, sometimes even at night. The need to urinate can come on suddenly, which can make travel, work, and some social situations difficult or awkward. In severe cases BPH can completely block your ability to pass urine. This can cause kidney damage if it is not treated promptly.

It is best to have this procedure before urine symptoms become severe or the prostate gland becomes too large. It is a good choice if you are not a good candidate for general or spinal anesthesia because TUNA can often be done under local anesthesia.

Examples of alternatives to this procedure include medicine as well as other surgical procedures, such as transurethral incision of the prostate (TUIP) and transurethral resection of the prostate (TURP). Ask your healthcare provider about your choices for treatment.

How do I prepare for this procedure?

Find someone to give you a ride home after the procedure. It's also a good idea to arrange for help or for someone to check on you the first day or two after surgery.

If you may be going home with a catheter for a few days after the procedure, ask for instructions on how to use the catheter and urine collection bag before your surgery. You will be more alert and more likely to understand and remember the directions before your surgery than right after it.

On the day of surgery, do not eat or drink anything before the surgery, not even coffee, tea, or water. If you take some medicines daily, ask your healthcare provider if you should take any of your medicines before surgery. If you take blood thinners, daily aspirin, or anti-inflammatories such as ibuprofen (e.g., Motrin or Advil) or naproxen (Aleve), ask your provider if you need to stop them before surgery. If you do need to stop taking your medicines, ask your provider when you can start taking them again. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery.

Follow any other instructions your healthcare provider gives you.

What happens during the procedure?

You will be given local anesthesia to numb the penis and urethra. You will have an IV (intravenous line), so you can be given more pain medicine if necessary. The surgeon will pass a slim, lighted, flexible tube called a cystoscope into the urethra. With the scope he or she will be able to see the area where the enlarged prostate is causing problems with passing urine. The surgeon will put needles into the enlarged areas of the prostate gland and send high-frequency radio waves through the needles. The radio waves will destroy the tissue around the needles.

What happens after the procedure?

Many men can go home the same day as their surgery. If you had something more than just a local anesthetic for the procedure, you may need to stay overnight.

Your provider may want to make sure that you are able to pass urine before you go home. Some men are able to go home using a catheter for a day or two. A catheter is a tube inserted into the urethra to help drain urine. Most men are able to go back to work in 1 to 2 weeks.

Ask your provider how to care for yourself and when you should come back for a checkup.

What are the benefits?

This procedure can relieve symptoms with only minor surgery and local anesthesia. Research is showing that over 75% of men who have had TUNA are doing well and having few or no symptoms 5 years after their surgery.

What are the risks?

With even minor surgery there is risk of infection or bleeding. Painful urination and blood in your urine are common for the first day or two. You may have problems passing urine and may need to use a catheter for a few days.

Because this procedure has been used for treatment of BPH for just a few years, there is not a lot of information about long-term side effects or outcomes. However, so far the results seem to be very good relief of urinary symptoms with few or no major complications compared to major prostate surgery (TURP).

When should I call my healthcare provider?

After surgery, follow your provider's instructions for taking care of yourself. If you have not been given specific instructions, here are some guidelines:

Call your provider right away if:

• You are having more pain.
• You have a fever of 100°F (37.8°C) or higher.
• You are having more pink or red urine in your catheter bag than expected.
• You cannot pass urine.
• You cannot use the catheter you were given.

Call during office hours if:

• You have a question about your follow-up appointment or care