Transurethral needle ablation (TUNA)

Transurethral needle ablation (TUNA) is an outpatient procedure to treat urinary symptoms caused by an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH). This procedure is also called radiofrequency ablation or RF therapy.

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 a pair of tiny needles into the prostate tissue that is pressing on the urethra. Then radio waves are passed through the needles to create scar tissue. This scarring shrinks prostate tissue, opening up the urinary channel so that urine can flow more easily.

TUNA is one of several options for treating 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 Risks How you prepare What you can expect Results

TUNA is used to ease urinary symptoms and complications resulting from blocked urine flow, such as:

  • 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

A number of procedures are available to treat BPH. In the long term, TUNA may be less effective than surgical options, such as transurethral resection of the prostate (TURP) and open prostatectomy. But TUNA has several advantages over traditional surgery:

  • It's typically done without an overnight hospital stay (on an outpatient basis).
  • It's less likely to cause 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 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).
  • New onset or worsening urinary symptoms. In some cases, TUNA can result in a chronic inflammation within the prostate that can cause irritative urinary symptoms such as frequency, urgency and in some cases pain with urination.

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.

Follow your doctor's instructions on what to do before your treatment. Here are some issues to discuss with your doctor:

  • Your medications. Tell your doctor about any prescription, over-the-counter or supplements you take. This is especially important if you take blood-thinning medications, such as warfarin (Coumadin) or clopidogrel (Plavix), and nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others). Your surgeon may ask you to stop taking medications that increase your risk of bleeding several days prior to the surgery.
  • Fasting before the 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.
  • Arrangements after the procedure. You won't be able to drive yourself home after the procedure. Plan to have someone available to drive you home. Ask your doctor ahead of time how long you can expect to be at the surgery center or hospital.
  • Activity restrictions. Your doctor will likely ask you to avoid any strenuous activity, such as heavy lifting, for three to five days. Don't have sex until your doctor says it's OK. Most men can resume sexual activity after a few weeks.
  • Bowel prep. 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.

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'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

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.

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.

Side effects of TUNA can include:

  • Blood in your urine (hematuria). This shouldn't last for more than a few days after the procedure.
  • Irritating urinary symptoms. You may experience painful urination, difficulty urinating, or an urgent or frequent need to urinate. These symptoms usually improve within a week or so.
  • Temporary difficulty urinating or urinary retention. 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.

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.


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