Transurethral needle ablation of the prostate (TUNA) | |
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ICD-9-CM | 60.97 |
Transurethral needle ablation (also called TUNA or transurethral radiofrequency ablation) is a technique that uses low energy radio frequency delivered through two needles to ablate excess prostate tissue. A cystoscope/catheter deploys the needles toward the obstructing prostate tissue and is inserted into the urethra directly through the penis under local anesthetic before the procedure begins. The energy from the probe heats the abnormal prostate tissue without damaging the urethra. The resulting scar tissue later atrophies, reducing the size of the prostate which in turn reduces the constriction of the urethra. It can be done with a local anesthetic on an outpatient basis. [1] It takes about an hour to perform the procedure. [2] It takes about 30 days for the ablated prostate tissue to resorb. [3]
Transurethral needle ablation can be used to treat benign prostatic hyperplasia (BPH). [4]
Some clinical studies have reported that TUNA is safe and effective, improving the urine flow with minimal side effects when compared with other procedures, such as transurethral resection of the prostate (TURP) and open prostatectomy. [1] [5] [6] However, other studies have reported that the procedure has a high failure rate, with the majority of patients requiring retreatment. [7] Some patients have reported long-term inflammation of their prostate after undergoing the TUNA process. This is known as chronic prostatitis.
The TUNA system was pioneered by Stuart Denzil Edwards. The device was the main product for a startup company called Vidamed. Vidamed was founded in 1992 by Edwards along with Ron G. Lax, Hugh Sharky and Ingemar Lundquist, in Menlo Park, California, before building an international global corporation headed up by Lyle F. Brotherton. Vidamed was floated in an IPO on the US NASDAQ stock market in 1995 and then acquired by Medtronic in 2001. [10] In 2011, Urologix, Inc. acquired the worldwide exclusive license to Prostiva radiofrequency therapy. [11]
The prostate is both an accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found only in some mammals. It differs between species anatomically, chemically, and physiologically. Anatomically, the prostate is found below the bladder, with the urethra passing through it. It is described in gross anatomy as consisting of lobes and in microanatomy by zone. It is surrounded by an elastic, fibromuscular capsule and contains glandular tissue as well as connective tissue.
Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control. Complications can include urinary tract infections, bladder stones, and chronic kidney problems.
Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladder control, mild lower abdominal pain, and a weak urine stream. Those with long-term problems are at risk of urinary tract infections.
Transurethral resection of the prostate is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. It has been the standard treatment for BPH for many years, but recently alternative, minimally invasive techniques have become available. This procedure is done with spinal or general anaesthetic. A triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Outcome is considered excellent for 80–90% of BPH patients. The procedure carries minimal risk for erectile dysfunction, moderate risk for bleeding, and a large risk for retrograde ejaculation.
Prostatic congestion is a medical condition of the prostate gland that happens when the prostate becomes swollen by excess fluid and can be caused by prostatosis. The condition often results in a person with prostatic congestion feeling the urge to urinate frequently. Prostatic congestion has been associated with prostate disease, which can progress due to age. Oftentimes, the prostate will grow in size which can lead to further problems, such as prostatitis, enlarged prostate, or prostate cancer.
Posterior urethral valve (PUV) disorder is an obstructive developmental anomaly in the urethra and genitourinary system of male newborns. A posterior urethral valve is an obstructing membrane in the posterior male urethra as a result of abnormal in utero development. It is the most common cause of bladder outlet obstruction in male newborns. The disorder varies in degree, with mild cases presenting late due to milder symptoms. More severe cases can have renal and respiratory failure from lung underdevelopment as result of low amniotic fluid volumes, requiring intensive care and close monitoring. It occurs in about one in 8,000 babies.
Saw palmetto extract is an extract of the fruit of the saw palmetto. It is marketed as a treatment for benign prostatic hyperplasia, but there is no clinical evidence that it is effective for this purpose.
The International Prostate Symptom Score (IPSS) is an eight-question written screening tool used to screen for, rapidly diagnose, track the symptoms of, and suggest management of the lower urinary tract symptoms of benign prostatic hyperplasia (BPH).
A prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms (LUTS). Prostatic obstruction is a common condition with a variety of causes. Benign prostatic hyperplasia (BPH) is the most common cause, but obstruction may also occur acutely after treatment for BPH such as transurethral needle ablation of the prostate (TUNA), transurethral resection of the prostate (TURP), transurethral microwave thermotherapy (TUMT), prostate cancer or after radiation therapy.
Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra and, in men, the prostate. The term is more commonly applied to men—over 40% of older men are afected—but lower urinary tract symptoms also affect women. The condition is also termed prostatism in men, but LUTS is preferred.
Transurethral microwave thermotherapy (TUMT) is one of a number of effective and safe procedures used in the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia. It is an alternative treatment to pharmacotherapy such as alpha blockers, transurethral resection of the prostate (TURP), transurethral needle ablation of the prostate, photoselective vaporization of the prostate and prostatic removal or prostatectomy.
Urologic diseases or conditions include urinary tract infections, kidney stones, bladder control problems, and prostate problems, among others. Some urologic conditions do not affect a person for that long and some are lifetime conditions. Kidney diseases are normally investigated and treated by nephrologists, while the specialty of urology deals with problems in the other organs. Gynecologists may deal with problems of incontinence in women.
Transurethral incision of the prostate is a surgical procedure for treating prostate gland enlargement.
Overflow incontinence is a concept of urinary incontinence, characterized by the involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate. This condition occurs in people who have a blockage of the bladder outlet, or when the muscle that expels urine from the bladder is too weak to empty the bladder normally. Overflow incontinence may also be a side effect of certain medications.
GreenLight Laser Therapy uses a laser beam to remove prostate tissue. The laser treatment is delivered through a thin, flexible fiber, which is inserted into the urethra through an instrument called a cystoscope.
Prostatic artery embolization is a developing non-surgical technique for treatment of benign prostatic hypertrophy (BPH). Although there is increasing research on PAE, use of the technique remains at an incipient stage.
If medical treatment is not effective, surgery may need to be performed for benign prostatic hyperplasia.
Aquablation therapy (AquaBeam) is a surgical procedure for men with lower urinary tract symptoms resulting from benign prostatic hyperplasia (BPH). It is in the early stages of study. It is not categorized as minimally invasive as general anesthesia is required. The procedure was developed by PROCEPT BioRobotics and combines real-time visualization through a cystoscope and a bi-plane ultrasound, while using a high-velocity sterile saline heat-free waterjet and autonomous robotics to remove prostate tissue.
Prostate steam treatment (Rezum), also called water vapor thermal therapy (WVTT), is a minimally invasive surgical procedure for men with lower urinary tract symptoms resulting from prostate enlargement. It uses injections of steam to remove obstructive prostate tissue from the inside of the organ without injuring the prostatic part of the urinary tube.
Prostatic urethral lift is a minimally invasive procedure for the treatment of benign prostatic hyperplasia. This procedure can be done under local anesthesia in an outpatient consultation.