BPH or Benign Prostate Hypertrophy is a non-cancerous growth of the male prostate gland, a condition that affects man men as they age.
Transurethral needle ablation is a technique used for the treatment of BPH. It is a minimally invasive procedure that is generally well-tolerated.
The FDA has approved the procedure for more than twenty years. It uses low-power radiofrequency energy to destroy (ablate) excess tissue from the prostate.
This excess growth of tissue in the prostate is what causes the urinary and other symptoms of BPH.
To perform the procedure, a healthcare provider inserts a surgical instrument called a cystoscope into the urethra, starting a the tip of the penis and feeds it up through the urethra until it reaches the area where the prostate enlargement is partially blocking urine flow.
The cystoscope contains a hollow tube through which instruments and medication can be passed.
How the TUNA procedure is performed
After the cystoscope is in position, the doctor may insert an anesthetic agent to minimize and pain from the procedure.
Pain medication is generally used minimally. It is essential that the patient not be desensitized entirely, so the healthcare provider does not use too much energy to ablate the tissue.
The doctor then guides a tube containing a pair of tiny needles through the cystoscope into the area(s) where the blockage is present. The needles are specially positioned in the tube and connected to a generator that produces radiofrequency energy.
The needles are inserted through the urethra into adjacent lateral lobes of the prostate.
When the radio frequency (RF) power is applied, the tissue between them is heated to a level (approximately 230 degrees Fahrenheit, which causes coagulation. The dead coagulated tissue is later absorbed by the body.
When the provider is certain, the needles are in position at the urethral blockage. The generator is triggered to produce a short burst of radiofrequency energy at the tips of the needles. The voltage generates heat that ablates the tissue and creates scar tissue.
The success of the procedure depends on the bodies’ gradual absorption of the dead and scarred tissue. As the body absorbs the tissue, urine flows more easily. Thus, it may take a few weeks or more for the procedure to fully take effect.
Patient selection considerations
While TURP is the most common medical procedure recommended by medical practitioners for the treatment of BPH, many men are happy to avoid treatment (such as a TURP) that can cause retrograde ejaculation.
While retrograde ejaculation is not a severe functional disability, it is unacceptable for many men. A TUNA procedure is minimally invasive and can help prevent the progression of BPH into severe genitourinary conditions.
Urinary retention is often a result of a long time untreated BPH and can be a serious condition that can cause severe kidney damage. This is particularly true of men of advanced age. A TUNA procedure may relieve many of their symptoms for several years.
TUNA is an option for patients who have failed treatment using medication or natural remedies. It is minimally invasive, there is no hospital stay needed, and it can be done as an outpatient procedure with low-level topical rather than risky general anesthesia.
Patients with extremely large prostates may face additional risks with a TURP that is not an issue with the TUNA procedure.
Risks of Transurethral Needle Ablation
TUNA is generally a minimally invasive procedure that has few significant complications.
However, like any procedure that is destroying or cutting away tissue, it carries some risks as follows:
- Urinary symptoms. TUNA can often resolve many urinary problems associated with BPH. Some men acquire inflammation or infection after the procedure that can result in chronic prostatitis. This can cause increased or urgent need to urinate, and some cases result in painful urination.
- Catheterization. Like most prostate procedures, a catheter is placed in the bladder and worn for a few days until the patient can urinate independently. This is usually a temporary situation, but the longer the catheter remains in place, the greater the risk of a urinary tract infection (UTI). Depending on the severity of the UTI, antibiotics might be needed to treat it.
- Erectile dysfunction. Virtually all treatments for BPH carry a risk of newly acquired or worsening erectile dysfunction after treatment. The risk with TUNA is relatively small and significantly lower than with other traditional treatments.
- Need for retreatment. TUNA is less effective at treating urinary symptoms than other treatments. Up to 1/3 of men treated with TUNA, need retreatment, either with TUNA or another procedure.
Benefits of Transurethral Needle Ablation (TUNA)
TUNA is generally a well-tolerated procedure. It′s main advantages include:
- No hospital stay. TUNA is typically done in a medical office on an outpatient basis. For men with multiple co-morbidities, it is likely the safest option for the treatment of BPH. The TURP procedure has a much higher morbidity rate.
- Less bleeding. Since TUNA is ablating tissue via heat rather than surgical removal, there is far less bleeding incurred with a TUNA procedure. It is a more feasible option for men of advanced age, those that regularly use blood thinners, have a bleeding disorder or other co-morbidities.
Comparative efficacy – TUNA vs. TURP
Transurethral resection of the prostate (TURP) was initially developed in the United States in the mid-1900′s. It has been generally considered the gold standard for low level minimally aggressive surgical management of BPH since.
The TUNA procedure can resolve many of the symptoms of BPH but is far less invasive. It is thus more useful for men of advanced age, has bleeding defects of other co-morbidities.
The TURP is performed similarly to a TUNA procedure, beginning with the insertion of a cystoscope into the urethra.
While the TUNA procedure uses electro-cauterization to cause tissue necrosis, the TURP removes excess prostate tissue by cutting it away using a variety of cutting instruments, including laser technology.
The TURP procedure can result in complications that include failure to void, urinary tract infection, uncontrolled bleeding, and erectile dysfunction. Up to 5 percent of TURP procedures require surgical revision. 1, 2
One relatively serious side effect of a TURP is a condition called TURP syndrome. This condition is caused by the absorption of irrigating fluid used to flush removed tissue from the surgical field.
While relatively rare, it can cause convulsions, coma, and death. The excess irrigating fluid enters the circulation via blood vessels in the resection area and can cause severe electrolyte imbalance. 3
The disadvantages of the TUNA procedure when compared to a TURP. Include:
- Revision Rate. TUNA has a higher failure rate than a TURP. Up to about 27 percent of participants require additional treatment.
- Reduced Urinary Improvement. While TUNA indeed provides substantial improvements, TURP provides more significant symptom relief and urinary flow improvements over time, albeit with the increased risk of surgery.
Alternative treatments
There are numerous alternatives to the TUNA procedure.
It is wise to get a second or even a third opinion to make sure a recommended procedure is suitable for the particular problem.
There are essentially four general categories of treatment for BPH. Each category has multiple options, and each option has different side effects and benefits. The four general categories are:
- Natural Remedies. This category includes lifestyle changes, nutritional support, and herbal supplements. In many countries outside the US, natural remedies are the first-line treatment for BPH. Natural treatment should be considered before more aggressive medical treatment. For many men, such treatment is highly effective. 4
- Medications. The first line of treatment for BPH is often medication. Generally, medications are viable for men that have bothersome symptoms, but no indication of other abnormalities in the prostate or urinary bladder, and no serious co-morbidities. Alpha and Beta-blockers are typically prescribed as well as 5-Alpha-reductase Inhibitors.
- Minimally Invasive Procedures. Like TUNA and TUMT. While these two procedures are performed similarly and have similar side effects and efficacy, they are technically quite different. The TUNA procedure destroys the tissue by passing radiofrequency energy through it, while the TUMT uses micro-wave energy for the same effect. Both procedures can help reduce urinary frequency, urgency, straining, and intermittent flow.
Note: Many of the reports and studies on-line intermingle the terminology of “radiofrequency energy” and “microwave energy” when describing the TUNA or TUMT procedures. From a technical standpoint, they are quite different in the way the energy is applied, but there are few therapeutic differences.
- Surgery. Surgery is often recommended when medications or less invasive procedures fail to halt or improve bothersome symptoms. There are two types of surgery that can be performed for BPH, TURP and a prostatectomy or total removal of the prostate. A prostatectomy is rarely recommended as a first-line treatment unless there are extenuating circumstances. Prostatectomy carries many unacceptable side effects and is seldom recommended as a first-line treatment for BPH.
There are many medical therapies for resolving BPH. See this report for a comprehensive summary of available treatments. 5
Conclusions
Enlarged prostate (BPH) is very common in men over 55 years old. It is often marked by urinary hesitation, inability to control the urine stream as effectively as before, and frequent waking at night to urinate (nocturia).
Men who are faced with this situation must realize that while treatment may be needed, aggressive treatment for a first-time incident is not always necessary.
For men with few severe symptoms, the TUNA procedure may be wholly appropriate and has the advantage of being minimally invasive with few serious side effects.
In cases of high risk of cancer progression and treatment relapse, surgical intervention may be necessary. We generally are against any invasive surgery, but we also think our readers should be informed, which is why we would share this
The majority of procedures damage the prostate and, therefore, cause short or long-term side effects. The only difference between them is that they use different technologies, but it doesn’t matter how you damage the prostate, it is damage.
Exceptions to this are Uro lift since it just relieves pressure on the urethra, but even that is still invasive.
The only truly minimally invasive procedure which does not damage the prostate is prostate artery embolization.
