Enlarged Prostate: Transurethral Needle Ablation

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Topic Overview

Transurethral needle ablation (TUNA) is used to treat an enlarged prostate gland (benign prostatic hyperplasia, or BPH) with a needle-shaped device that delivers heat to very precise areas of the prostate. The device is inserted up the urethra inside a tube (catheter) that protects other tissues from being burned. The heat destroys specific areas that are blocking the flow of urine out of the bladder. This relieves BPH symptoms. The procedure does not require an overnight stay in the hospital.

A year after TUNA surgery, symptoms can be about 13 points lower on the American Urological Association (AUA) symptom index. For most men, that means a 60% reduction in symptoms. For example, if your symptom score is 25 (severe), it could be reduced to about 10 (moderate). With transurethral resection of the prostate (TURP), symptoms can be reduced by about 85% in most men.1 But TUNA is less likely than TURP to cause complications.

Needle ablation has minimal complications. The two most common are an inability to urinate (urinary retention) in the first 24 hours after surgery and pain while urinating. Sexual ability is generally not affected.2

The main advantages of this treatment are:

  • It can be done without an overnight stay in the hospital.
  • It has a short recovery time, although the symptoms may take longer to improve.
  • It has minimal side effects.

The main disadvantages of this treatment are:

  • You are more likely to need another surgery for BPH later.3
  • It may not work well for men who have large prostates.

Reports have warned that in a small number of cases TUNA has caused serious injuries and complications,including damage to the penis and urethra. Injuries have required urostomies, partial amputation of the penis, andother procedures. In December 2000, the U.S. Food and Drug Administration (FDA) issued a warning about theseinjuries.

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References

Citations

  1. Fitzpatrick JM (2012). Minimally invasive and endoscopic management of benign prostatic hyperplasia. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2655–2694. Philadelphia: Saunders.
  2. AUA Practice Guidelines Committee (2010). AUA guideline on management of benign prostatic hyperplasia. Chapter 1: Guideline on the management of benign prostatic hyperplasia (BPH). Available online: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bph.
  3. Lourenco T, et al. (2008). Minimally invasive treatments for benign prostatic enlargement: Systematic review of randomised controlled trials. BMJ, 337(7676): a1662–a1669.

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Credits

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer J. Curtis Nickel, MD, FRCSC - Urology

Current as ofJune 4, 2014