Transurethral Needle Ablation of Prostate (TUNA or Prostiva)
Transurethral needle ablation, or TUNA, is also called radiofrequency therapy, and refers to a procedure in which heat is used to destroy a section of the prostate. Radiowaves create heat which kills the cells that create the blockage. Thus, urine flow and correct prostate function may be restored. During TUNA, a small tube containing a camera (called a cytoscope) is threaded through the urethra, and small needles are inserted in to the prostate gland with the assistance of the tiny camera. The needles are used to transfer radio waves, and their heat destroys any cells with which the needles come into contact. Though the procedure is short (less than 45 minutes), it can be a bit painful. So patients are often put under general anesthesia. While men are catheterized, they are allowed to go home as soon as they can urinate without the use of a catheter. Because of the invasive nature of the procedure and the insertion of the cytoscope, antibiotics are required to prevent infection, and other medications such as anti-inflammatories are often prescribed.
Advantages over medications
This procedure is ideal for men who have mild to moderate obstruction of the urethra. It is not generally recommended for men with very large prostates. In addition, it is not a good choice for men with enlargement of the middle lobe of the prostate. It has been found to be more effective at relieving symptoms than medications, but appears to be less effective than TURP, or traditional removal of the prostate. Using symptom scoring, it reduces symptoms by approximately nine points.
Comparison of TUNA to Microwave Thermotherapy
There are many ongoing clinical trials and recent publications that debate the therapeutic value of BPH therapies. Each patient may find that a particular therapy is best for his condition and symptoms, as well as his medical history and personal goals. Recent developments seem to indicate that microwave thermotherapy may offer the most cost-effective and symptom-eliminating management of the condition, but many more randomized clinical trials need to be performed before there is a definitive best option. In addition, some men may opt for a more invasive procedure to more effectively manage more severe symptoms, whereas others may wish to treat the symptoms more gently. To completely eradicate symptoms, transurethral prostatectomy (TURP) appears to be the leading choice for removing obstructing tissue. But both TUNA and TUMPT offer cost-effective, less invasive ways to manage symptoms.
TUNA can be performed in a clinic or outpatient setting with local anesthesia and/or oral sedation. The ideal candidate for TUNA has obstructive symptoms from a prostate weighing less than 60 grams, and predominantly lateral lobes. Patients with larger prostates are better suited for other treatments. Most patients are sedated with valium or Demerol, and urethral gel. The patient needs to have sterile urine before the procedure can take place, and may need to be treated with antibiotics to ensure that the risk of infection is low. Antibiotics are recommended for 3-5 days following the procedure, and a patient usually wears a catheter for up to 3 days post-op. If patients ultimately do not see desired results following TUNA, they may be a candidate for either laser vaporization of the prostate using Greenlight laser or holmium laser or TURP. In a clinical trial, 30% of patients who were treated with TUNA or Microwave thermodilation ultimately underwent a TURP procedure, because the TUNA procedure did not treat their symptoms to the desired degree. However, it is important to note that the full effect of the TUNA procedure may take a full 3 months to completely appear.