Transurethral needle ablation (TUNA)

Transurethral needle ablation (TUNA) is a minimally invasive surgical procedure of the prostate that uses heat to remove the prostate tissue. The heat used is generated by using low-level radiofrequency energy. This is done for individuals whose prostate enlargement is moderate between 30-80 cc.

Anatomy:

The prostate is a reproductive organ in males situated in the male's lower part of the pelvis. It is present between the penis and the urinary bladder. It looks like a cone and has five lobes. It produces fluid that keeps the sperm healthy. prostate-specific antigen that plays an important in the male fertility and motility of the sperm is secreted by it.

Benign prostate hyperplasia (BPH):

BPH is a condition of the prostate. It commonly affects the older age group. It causes an increase in the size of the prostate. This enlarged prostate can pressurize the urethra narrowing it. This causes many symptoms like increased urge to urinate at night, increased frequency of urination, and inability to empty the bladder.

Technique:

TUNA is done to treat BPH. It is a kind of heat therapy. It uses heat to remove the excess tissue in BPH. Low-level radiofrequency energy is used to remove the excess prostate. The RF energy is applied in the form of electrical energy by using two electrodes. One electrode is active. An electrical current is generated by keeping the electrodes in contact with the tissue. This generated current is resisted by the tissues which produce heat energy due to the presence of water molecules. This heat causes coagulation of the excess prostate and removes it.

Indications:

TUNA is indicated in moderate BPH of 30-80cc. It is done to reduce the symptoms of BPH like increased frequency of urination, urge of urination, difficulty in starting to urinate, prolonged urination, increased frequency of nighttime peeing, discontinuous flow of pee, inability to empty the bladder, and frequent urinary tract infections.

Contraindications:

It is not indicated in larger enlargements of the prostate and when the urinary obstruction is severe.

Advantages:

There are many advantages of TUNA.

It is a safe and effective process that requires minimal invasiveness in men with small enlargements
It has a low risk of bleeding and is safe in individuals who use blood thinners or who have bleeding disorder
It can be done as an outpatient procedure and needs less hospital stay
This procedure has relatively fewer adverse effects due to the procedure
It takes less time than transurethral resection of the prostate
Catheterization time is also less
It is simple and cost-effective
It need not be done only under general or spinal anesthesia
It is a one-time intervention procedure

Before the Procedure:

Before TUNA, it is important to understand the importance of the procedure by discussing it with the healthcare provider (HCP). Complete details regarding the medical, surgical, allergic, and medication history should be given to the HCP. Diet will be restricted and a list of medications to be stopped and another list of medicines to be used before the procedure will be given. One has to undergo certain blood tests to understand the current medical condition.

Certain advanced imaging studies like MRI or CT are carried out to evaluate the extent of the disease. TUNA will be done on an empty stomach under anesthesia. Hence it is necessary to refrain from eating anything 8-12 hours before the procedure. Inform the healthcare provider of any previous allergies to anesthesia.

During the Procedure:

TUNA will be done under local, intravenous, or spinal anesthesia based on the comfort of the patient. Spinal anesthesia blocks the sensation and pain from below the waist. Local anesthesia will be given through the urethra and the prostate by a gel or an injection.

To perform TUNA, the individual is placed in a supine position with legs raised. Anesthesia gel is applied at least 10 minutes before the procedure. A special device called a 0-degree lens and ultrasound is used to visualize the procedure. Protective shields are placed on the urethra to avoid damage to other organs.

Based on the ultrasound guidance, Radiofrequency energy is passed through the needles for five minutes per every excess growth tissue. About 20 cc of excess tissue is ablated every time. Low-power setting is given to the tissue to prevent excess heat generation and damage to adjacent tissues.

Treatment plans are created based on the size of the hypertrophy of the tissue. Using the excess heat generated each plane is removed.

After the procedure:

After the procedure, an individual can go home on the same day. Medications are given to reduce pain and ward off infection. About 1-3 days after the procedure, the catheter is removed. One can resume normal activities in 3 days but should avoid strenuous activities, thermal baths, or saunas for up to two weeks after the procedure is done. One can have sex about four weeks after the procedure. Pelvic floor exercises should be started to increase control over the pelvis area.

Effectiveness:

TUNA is an effective procedure in males with prostate enlargement of less than 30-80g and can reduce the signs and symptoms of BPH

Side effects:

Some side effects include the presence of blood in the urine for a few days after the procedure. Frequent urge to urinate, burning sensation at the tip of the penis, and at the end of urination are some of the side effects.

Risks and complications:

Certain risks with the procedure include occasional narrowing of the urethra, incidence of the flowing of semen back into the bladder during ejaculation, erection difficulties in those who did not have it prior, and recurrence of the symptoms needing another treatment.

Conclusion:

TUNA is a minimally invasive surgical procedure for benign prostate hypertrophy. It is done by the heat generated using radiofrequency current. It can reduce urinary symptoms caused due to BPH and improve the quality of life.

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