What is transurethral needle ablation? Transurethral needle ablation (or transurethral radiofrequency ablation, TUNA) of the prostate is an innovative minimally invasive procedure that is used to treat benign prostatic hyperplasia. The procedure is performed by inserting two needles (which emit radio waves) to ablate excess prostate tissue. Needles are inserted through the urethra into the lateral lobes of the prostate, causing heat-induced coagulation necrosis. The tissue is heated to 110 �C for approximately 3 minutes per lesion. How is transurethral needle ablation performed? The procedure uses a cystoscope, which is inserted into the urethra (the waste channel through which urine is removed from the bladder outside the body) directly through the penis under local anesthesia before the procedure begins. The cystoscope deploys the needles to the obstructing prostate tissue. The heat from the electrical energy is supplied by the 2 electrodes that are in contact with the patient. As the prostate cells resist the passage of current, heat energy is produced by friction and by heating water molecules. This leads to tissue heating and eventually coagulation necrosis. Thermal lesions (heat-damaged tissues) occur only in the localized area, because the signal is transmitted in the tissue only by direct contact. The energy from the electrodes heats the hypertrophied prostate tissue without damaging the urethra. The resulting fibrotic tissue later atrophies, reducing the size of the prostate, which in turn reduces the urethral stricture. Local anesthesia may be used for the technique. The procedure takes about an hour. It takes about 30 days for the ablated prostate tissue to be resorbed. What are the indications for transurethral needle ablation? Some clinical studies have reported that transurethral needle ablation is a safe and effective procedure that improves urine flow with minimal side effects compared to other procedures, such as transurethral resection of the prostate (TURP) and open prostatectomy. However, other studies have reported that the procedure has a high failure rate, with most patients requiring retreatment. In some cases, long-term inflammation of the prostate (chronic prostatitis) has been reported after transurethral needle ablation. Minimally invasive therapy is an option for therapy after failed treatment of benign prostatic hyperplasia. Transurethral needle ablation is also used in patients who do not wish to undergo transurethral resection of the prostate (TURP). In general, transurethral needle ablation is considered suitable for men with obstructive symptoms (complaints of obstruction to urine flow) and an enlarged prostate (but lighter than 60g). Patients found to have enlarged prostatesother forms of treatment may be offered. Transurethral needle ablation is best suited for patients with benign prostatic hyperplasia (BPH) who cannot tolerate the side effects of medications or are unwilling to commit to long-term therapy. The procedure is also suitable for patients who are at high risk of complications from general anesthesia for invasive procedures. What are the contraindications for performing transurethral needle ablation? Contraindications for transurethral needle ablation include: Active urinary tract infection; Neurogenic, decompensated or atonic bladder; Urethral strictures or muscle spasms that interfere with the procedure; Blood coagulation disorders or taking anticoagulants, unless the drug has been stopped for at least 10 days before the procedure; Patients who are not in good general health; Clinical or histological evidence of prostate cancer or bladder cancer; A prostate gland with a transverse diameter of less than 34 mm or greater than 80 mm; Presence of any prosthetic device that may interfere with the procedure; Patients whose prostate has previously been treated with non-pharmacological therapies; Presence of a cardiac pacemaker, implantable defibrillator or penile implant; Availability of implantable neurostimulation devices References: 1. Yu X, Elliott SP, Wilt TJ, McBean AM. Practice patterns in benign prostatic hyperplasia surgical therapy: the dramatic increase in minimally invasive technologies 2. Bouza C, L?pez T, Magro A, Navalpotro L, Amate JM. Systematic review and meta-analysis of Transurethral Needle Ablation in symptomatic Benign Prostatic Hyperplasia 3. eMedicine. Transurethral Needle Ablation of the Prostate (TUNA) 4. Kahn SA, Alphonse P, Tewari A, Narayan P. An open study on the efficacy and safety of transurethral needle ablation of the prostate in treating symptomatic benign prostatic hyperplasia: the University of Florida experiencewho are not in good general health; Clinical or histological evidence of prostate cancer or bladder cancer; A prostate gland with a transverse diameter of less than 34 mm or greater than 80 mm; Presence of any prosthetic device that may interfere with the procedure; Patients whose prostate has previously been treated with non-pharmacological therapies; Presence of a cardiac pacemaker, implantable defibrillator or penile implant; Availability of implantable neurostimulation devices References: 1. Yu X, Elliott SP, Wilt TJ, McBean AM. Practice patterns in benign prostatic hyperplasia surgical therapy: the dramatic increase in minimally invasive technologies 2. Bouza C, L?pez T, Magro A, Navalpotro L, Amate JM. Systematic review and meta-analysis of Transurethral Needle Ablation in symptomatic Benign Prostatic Hyperplasia 3. eMedicine. Transurethral Needle Ablation of the Prostate (TUNA) 4. Kahn SA, Alphonse P, Tewari A, Narayan P. An open study on the efficacy and safety of transurethral needle ablation of the prostate in treating symptomatic benign prostatic hyperplasia: the University of Florida experiencewho are not in good general health; Clinical or histological evidence of prostate cancer or bladder cancer; A prostate gland with a transverse diameter of less than 34 mm or greater than 80 mm; Presence of any prosthetic device that may interfere with the procedure; Patients whose prostate has previously been treated with non-pharmacological therapies; Presence of a cardiac pacemaker, implantable defibrillator or penile implant; Availability of implantable neurostimulation devices References: 1. Yu X, Elliott SP, Wilt TJ, McBean AM. Practice patterns in benign prostatic hyperplasia surgical therapy: the dramatic increase in minimally invasive technologies 2. Bouza C, L?pez T, Magro A, Navalpotro L, Amate JM. Systematic review and meta-analysis of Transurethral Needle Ablation in symptomatic Benign Prostatic Hyperplasia 3. eMedicine. Transurethral Needle Ablation of the Prostate (TUNA) 4. Kahn SA, Alphonse P, Tewari A, Narayan P. An open study on the efficacy and safety of transurethral needle ablation of the prostate in treating symptomatic benign prostatic hyperplasia: the University of Florida experience