What is transurethral needle ablation (TUNA)?

Marc B. Garnick, MD
Hematology & Oncology
Transurethral needle ablation (TUNA) -- a procedure that uses radio waves to heat and destroy prostate cells obstructing the urethra -- uses a small, spring-like mesh cylinder called a prostatic urethral stent, which is typically made of titanium. The doctor inserts the stent through the penis and, after positioning it in the narrowed area of the urethra, releases it to widen the channel, relieving pressure from the prostate tissue and allowing for easier urination. This quick procedure requires only local or spinal anesthesia, involves no loss of blood, and is often done in an outpatient surgical center.

Prostatic urethral stents aren't for everyone. They are most often used in elderly men who have severe prostate enlargement and whose overall health is so poor that surgery would be risky. In many cases, urinary obstruction gradually returns because of a process called hyperplastic epithelial reaction, in which prostate tissue protrudes through the mesh and causes renewed blockage. There's rarely a complete reblockage of urinary flow, but additional procedures may be required in some cases.

Transurethral needle ablation (TUNA) is used in the treatment of benign prostatic hyperplasia (BPH) ), or enlarged prostate, and was approved in the U.S. in 1996. The procedure, which takes about three to five minutes, uses needles that are passed through the urethra to ablate, or destroy, prostate tissue.

TUNA is an outpatient procedure that does not require anesthesia and uses a special catheter, similar to a rigid cystoscope with fiber optics, to view the prostate and guide the placement of the needles. The catheter, which is inserted through the urethra into the prostate, is equipped with two adjustable needles that are guided into precise areas of the prostate where low-radio-frequency energy is delivered. This energy heats the tissue slowly to a temperature of about 80F to 100F, which causes the death of prostate tissue by destroying the blood supply of the tissue and making it into a homogenous mass (a process known as coagulation necrosis). The coagulation causes tissue to shrink and to be absorbed by the body over a period of about eight weeks following treatment.

When the procedure is completed, a catheter is inserted to aid in emptying the bladder and is usually left in place for two to three days. There is typically blood in the urine for one day or so, and symptoms may be worse for two to four days until swelling subsides. It takes two to three weeks to notice an improvement in symptoms and two to three months for maximum improvement.

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