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Tuna Procedure For Enlarged Prostate

Benefits Of Transurethral Needle Ablation

Transurethral Needle Ablation (TUNA) of the Prostate for treatment of Urinary Complaints

Advantages of TUNA over other treatments for BPH include:

  • Lower risk of bleeding – Patients who are on blood-thinning medication may do better on this treatment because the risk of bleeding is less than with more invasive procedures.
  • Shorter hospital stays – can be done on an outpatient basis
  • Patients need less anesthesia

How Is Tuna Performed

For TUNA you will receive intravenous, spinal, or local anaesthesia. Once you are under anaesthesia, the doctor enters your bladder through the urethra. The doctor uses an endoscope which has two needles and a camera. The needles are used to puncture the prostate and to heat up the tissue with radiofrequency energy . This is done 4 to 8 times to treat the whole adenoma. The camera allows the doctor to see a high-quality image of the prostate on a video monitor.

You will need a catheter for some days until the urethra is healed and you can urinate on your own. The catheter is removed by the urologist at the hospital or clinic.

How The Tuna Procedure Is Performed

After the cystoscope is in position, the doctor may insert an anesthetic agent to minimize and pain from the procedure.

Pain medication is generally used minimally. It is essential that the patient not be desensitized entirely, so the healthcare provider does not use too much energy to ablate the tissue.

The doctor then guides a tube containing a pair of tiny needles through the cystoscope into the area where the blockage is present. The needles are specially positioned in the tube and connected to a generator that produces radiofrequency energy.

The needles are inserted through the urethra into adjacent lateral lobes of the prostate.

When the radio frequency power is applied, the tissue between them is heated to a level (approximately 230 degrees Fahrenheit, which causes coagulation. The dead coagulated tissue is later absorbed by the body.

When the provider is certain, the needles are in position at the urethral blockage. The generator is triggered to produce a short burst of radiofrequency energy at the tips of the needles. The voltage generates heat that ablates the tissue and creates scar tissue.

The success of the procedure depends on the bodies gradual absorption of the dead and scarred tissue. As the body absorbs the tissue, urine flows more easily. Thus, it may take a few weeks or more for the procedure to fully take effect.

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Risks Of A Transurethral Needle Ablation

Although TUNA is a relatively safe procedure, complications can occur. Complications may include:

  • Chronic inflammation of the prostate, which could cause painful urination or frequent need to urinate
  • Difficulty urinating for a few days after the procedure
  • Urinary tract infection
  • Erectile dysfunction, while rare, can occur
  • Need to be treated again

Prostiva Tuna Therapy For Enlarged Prostate: What You Need To Know

Enlarged Prostate

Transurethral Needle Ablation Therapy for BPH or enlarged prostate is a procedure that uses radiofrequency energy to shrink the size of the prostate. This treatment had been very popular in the 1990s because of the low risk of side effects, in particular ejaculation problems.

However, the radiofrequency needle ablation procedure, also known as the transurethral Needle Ablation Therapy , has fallen out of favor due to poor efficacy. In other words, the Prostiva procedure has a high failure rate. It tends not to help much with the symptoms of an enlarged prostate. When it does help, the benefit tends to be short-lived for a few years. TUNA of the prostate is also known as Prostivva RF treatment. A few other commercial systems were available in the past but no longer marketed. The Prostiva RF TUNA therapy is no longer recommended as a treatment option for an enlarged prostate due to poor efficacy, high failure rate, and availability of more effective treatment options.

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How Long Will It Take Me To Get Back To My Daily Activities

Usually, you can leave the hospital or clinic a few hours after TUNA. Do not drive a car when leaving the hospital because you may still be drowsy after the anaesthesia. Make sure you get enough rest on the day of the procedure.

With the catheter still in your urethra, you can start getting back to your daily activities the next day. Your urine may contain traces of blood which can last up to several weeks.

For 4-6 weeks after the surgery:

  • Drink 1-2 litres every day, especially water
  • Do not lift anything heavier than 5 kilograms
  • Do not do any heavy exercise and avoid bike riding
  • Do not take thermal baths or go to the sauna
  • Prevent constipation by adapting your diet
  • Discuss any prescribed medication with your doctor

Avoid having sex for 2-3 weeks. After TUNA, you may suffer from retrograde ejaculation. This is a chronic condition where semen can no longer leave through the urethra during orgasm. Instead it goes into the bladder and later leaves your body during urination. Your semen may be stained with blood for a few weeks.

You need to go to your doctor or back to the hospital right away if you:

  • Develop a fever
  • Face problems with the catheter
  • Cannot urinate on your own after the catheter is removed

Risks Side Effects And Considerations

TUNA is a safe and effective treatment for BPH with a relatively low rate of side effects.2 There are some risks and considerations that should be discussed with your urologist including: obstruction, bleeding or blood in urine, pain, increased urinary urgency or frequency and urinary tract infections.2

Speak to your urologist about the options available to you in your particular circumstance. You may also visit our Prostiva® RF Therapy web page to learn more about the procedure and how it can benefit you by improving the symptoms of BPH.

1Data derived from Flomax product labeling IT8004IH1309 www.fda.gov

2Data derived from Prostiva® RF System Manual 250369-001 Rev B 12/12

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Complications Of The Tuna Procedure

Transurethral needle ablation is a relatively safe and non-invasive procedure, however, possible complications include:

  • Swelling
  • Worsening urinary problems
  • Urinary tract infections

Some patients may require additional treatment because they develop long-term prostate irritation that can cause swelling and pain.

Minimally Invasive Surgical Therapy

Prostiva RF Therapy Procedure Animation

Minimally invasive surgical therapy consists of office-based therapies, such as transurethral needle ablation of the prostate, transurethral microwave therapy, or interstitial laser coagulation. Each of these therapies can be performed with minimal anesthesia and has shown significant improvement in symptom scores and flow rates. However, the durability of these therapies is still being assessed and each has a significant retreatment rate . Minimally invasive surgical therapies are a good option for those patients who are poor surgical candidates or who are concerned about surgical morbidities.

Jamal Islam, Alvah R. Cass, in, 2007

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How Does The Procedure Work

After anesthesia, a surgeon will insert a tool called a resectoscope into the urethra. In some cases, a separate device will be used to flush sterile fluid through the surgical site.

Once the surgeon has positioned the resectoscope, they will use it to cut away abnormal prostate tissues and seal broken blood vessels.

Finally, the surgeon will insert a long plastic tube called a catheter into the urethra and flush destroyed prostate tissues into the bladder where they are excreted through urine.

What You Can Expect

You’ll be given a local anesthetic to numb the prostate area. The anesthetic might be inserted through the tip of your penis, or given in a shot via your rectum or in the area between your scrotum and anus.

You might also have intravenous sedation. With IV sedation, you’ll be drowsy but remain conscious during the procedure.

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Introduction To The Tuna Procedure

Transurethral needle ablation of the prostate is a procedure used to treat benign prostatic hyperplasia . It is performed by placing interstitial radiofrequency needles through the urethra and into the lateral lobes of the prostate, causing heat-induced coagulation necrosis. The tissue is heated to 110°C at an RF power of 456 kHz for approximately 3 minutes per lesion. A coagulation defect is created.

Transurethral resection of the prostate was originally developed in the United States between 1920 and 1930 and was generally considered the criterion standard for surgical management of BPH.

Advances in the surgical treatment of BPH have come via applications of traditional electrosurgical current. TUNA is one of these minimally invasive treatments of prostatism. It began as a treatment in the early 1990s, with the first preliminary trials on humans in 1993. The first studies in the United States began in 1994, and the US Food and Drug Administration approved TUNA of the prostate in 1996.

However, a decline in the use of this procedure has occurred as newer techniques to treat BPH have arisen and become more popular. Contributing to its decline, TUNA has also been noted to have a high retreatment rate at 20 months follow-up.

Expectations After A Tuna

BPH

Over the course of the next several weeks, the treated tissue will slowly be absorbed into the body. As the body absorbs the extra tissue, the prostate begins to shrink and the patient will see incremental improvements in their symptoms. Patients will experience the full degree of improvement within 10 weeks of the procedure. We quote a 75-80% success rate with TUNA/Prostiva, and success, on average, lasts 5 years.

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Questions To Ask Before Surgery

As you think over the options for surgery, ask your doctor these questions:

  • Is there a good chance my condition will get better?
  • How much will it improve?
  • What are the chances of side effects from a treatment?
  • How long will the effects last?
  • Will I need to have this treatment repeated?

With newer technologies, doctors can do some minimally invasive procedures with tiny cuts or use tube-style instruments that they insert into you. These procedures may not treat the symptoms to the same degree or durability as more invasive surgical options, they do have faster recoveries, less pain afterward and have reduced risks.

Other times, the traditional and more invasive surgery may be needed. It all depends on your case and what you and your doctor decide is best for you.

Doctors can choose from these minimally invasive procedures, endoscopic, or open surgeries to treat moderate to severe symptoms. These procedures are also used if tests show that your ability to pee is seriously affected.

Other Things To Consider

Before you have one of these procedures, talk with your doctor about whether youâll be given something to numb the area or whether youâll be given something so you wonât be awake during the procedure. What you get and where you have it depends on the procedure.

Your doctor will give you instructions on how to prepare for any of them.

Surgery can ease many BPH symptoms, but it may not relieve them all. If there are certain complications, such as a weak bladder, there may still be urinary problems after surgery, although this is rare.

With any BPH surgery, there may be side effects or complications such as bleeding, narrowing of the urine tube also known as urethral stricture, urinary incontinence or leakage, erectile dysfunction, and retrograde ejaculation.

The best treatment for an enlarged prostate is not the same for every man. Talk to your doctor about the risks and benefits of each procedure.

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What To Expect During A Transurethral Needle Ablation

TUNA is typically performed in your doctors office under local anesthesia.

During the procedure, a cystoscopy with a needle connected to the end is inserted through the penis into the prostate. A cystoscope is a surgical instrument with a light on the end that allows the doctor to see the urethra. Low level radio waves are sent through the needles into various areas of the prostate gland to destroy excess cells.

Your doctor will determine how many needles need to be placed into the prostate and how long each one will be placed at each location based on the size and shape of the prostate. Typically, four to six needles are used and are held on each location for as long as three minutes.

When To See A Doctor

Understanding BPH

Most people begin to feel better and have an improved urine flow within 4 to 6 weeks after TURP surgery.

Overall, the risk of serious complications after TURP surgery is quite low. But as with all surgeries, there are some potential health risks associated with the procedure that require medical attention and intervention.

Reasons to seek medical attention after TURP surgery include:

  • bleeding from the urethra, outer prostate, or penis
  • inflammation and pain in the urethra, prostate, or penis lasting longer than 2 weeks or worsening
  • reduced urine flow or urinary symptoms, such as incontinence or urinary urgency 6 weeks post-surgery
  • blood in the urine that is severe or lasts longer than 4 to 6 weeks
  • severe clots of blood in urine or urine that is entirely red
  • weakness and fatigue that does not improve after 4 weeks
  • impotence or erectile dysfunction

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What Are The Risks Of This Procedure

Every procedure or treatment has risks. Some possible risks of this procedure include:

  • You may have problems with anesthesia.
  • You may have infection, blood clots, or bleeding.
  • Your bladder could be damaged. This can cause discomfort with urination or you may not be able to pass urine.
  • The muscle around your urethra may be permanently damaged. This could make it hard to control your urine.

Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.

Indications For The Performance Of Tuna

Minimally invasive therapy is an option after failed medical management for benign hyperplasia of the prostate. This therapy is also the primary treatment for patients who are not interested in medical therapy and are unwilling to undergo TURP.

Generally, the ideal patient for TUNA is thought to be a man with obstructive symptoms and a prostate of 60 g or less with predominantly lateral lobes. Patients found to have larger glands may be offered different forms of treatment.

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Diagnosis Of An Enlarged Prostate

An enlarged prostate is diagnosed after a thorough physical examination by a doctor, which may also include the following additional tests:

  • Digital rectal exam
  • Prostate specific antigen test or PSA
  • Cystoscopy

A series of urodynamic tests may also be performed to evaluate the function of the bladder and the urinary tract.

The Initial Causes Tuna Procedure Prostate Side Effects

Microwave Surgery For ProstateBestMicrowave

One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.

Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.

If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.

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Risks Of Transurethral Needle Ablation

TUNA is generally a minimally invasive procedure that has few significant complications. However, like any procedure that is destroying or cutting away tissue, it carries some risks as follows:

  • Urinary symptoms. TUNA can often resolve many urinary problems associated with BPH. Some men acquire inflammation or infection after the procedure that can result in chronic prostatitis. This can cause increased or urgent need to urinate, and some cases result in painful urination.
  • Catheterization. Like most prostate procedures, a catheter is placed in the bladder and worn for a few days until the patient can urinate independently. This is usually a temporary situation, but the longer the catheter remains in place, the greater the risk of a urinary tract infection . Depending on the severity of the UTI, antibiotics might be needed to treat it.
  • Erectile dysfunction. Virtually all treatments for BPH carry a risk of newly acquired or worsening erectile dysfunction after treatment. The risk with TUNA is relatively small and significantly lower than with other traditional treatments.
  • Need for retreatment. TUNA is less effective at treating urinary symptoms than other treatments. Up to 1/3 of men treated with TUNA, need retreatment, either with TUNA or another procedure.

Candidates For The Tuna Procedure

There are several procedures available to treat BPH, however, the TUNA procedure may be preferred if the patient is not a good candidate for surgery due to health problems or problems related to general anesthesia. It is often a treatment option chosen by BPH patients who may be at risk for more invasive surgery.

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Contraindications To The Performance Of Tuna

The manufacturer lists the following contraindications to TUNA therapy:

  • Active urinary tract infection

  • Neurogenic, decompensated, or atonic bladder

  • Urethral strictures or muscle spasms that prevent insertion of the cartridge sheath

  • Bleeding disorders or patients taking anticoagulation medication unless antiplatelet medication has been discontinued for at least 10 days

  • ASA class group V patients

  • Clinical or histological evidence of prostatic cancer or bladder cancer

  • Prostate gland that is less than 34 mm or greater than 80 mm in transverse diameter

  • Presence of any prosthetic device in a region that may interfere with the procedure

  • Patients whose prostate has previously been treated with nonpharmacologic therapies

  • Presence of cardiac pacemaker, implantable defibrillator, or malleable penile implants

  • Patients with any component of an implantable neurostimulation system

Very limited experience has been gained regarding the use of TUNA to treat patients with high bladder necks. At this time, these patients should probably be treated with another form of therapy.

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