eMedicine Specialties > Urology > Benign Prostatic Hypertrophy

Transurethral Needle Ablation of the Prostate (TUNA): Workup

Author: Nicolas A Muruve, MD, FRCSC, FACS, Associate Staff, Department of Urology, Cleveland Clinic Florida
Coauthor(s): Keith Steinbecker, MD, Consulting Staff, Department of Urology, St John's Mercy Medical Center; T Brian Willard, MD, Consulting Staff, Department of Surgery, Division of Urology, Lexington Urological Associates
Contributor Information and Disclosures

Updated: Feb 7, 2008

Workup

Laboratory Studies

  • In general, no set workup studies have been determined beyond the standard history and physical examination, which are required before transurethral needle ablation (TUNA) can be performed. In fact, one advantage of TUNA (as compared with TURP) is that a general or spinal anesthesia is not required. The most common reason for intervention is symptoms of bladder outlet obstruction and bladder irritability, which interfere with the patient's quality of life. The AUA Symptom Score and the IPSS are indices that attempt to quantify the degree of symptoms. Typically, patients whose symptoms fail to respond to watchful waiting or medical therapy are offered surgical intervention. More absolute indications for intervention include acute urinary retention, recurrent infection, azotemia, and cystolithiasis.
  • Performing a set of chemistries and a CBC count with differential is prudent for the evaluation of a patient's general health. Specifically, evaluate creatinine to assess for obstructive uropathy.
  • One should screen for prostate cancer with a serum prostate-specific antigen (PSA) study and a digital rectal examination.

Imaging Studies

  • No imaging studies are needed.

Other Tests

  • Urodynamics are not necessary, but uroflowmetry, postvoid residual urine volumes, and pressure-flow studies may provide additional information for diagnosis and may offer the chance that a prostatectomy may be beneficial. However, these tests are not uniformly recommended because they are difficult to interpret and the results are often irreproducible.

Diagnostic Procedures

  • No preoperative procedures are necessary. Preoperative transrectal ultrasonography and cystoscopy may be useful to determine the optimal form of surgical treatment. 
    • The fact that the size of the prostate does not correlate with the degree of symptoms is well known. Thus, ultrasonography to evaluate for the size of the prostate would not help in the diagnosis. Also, performing a cystoscopy to evaluate for size would similarly not be helpful in establishing a diagnosis of benign prostatic hypertrophy (BPH). However, in the population of patients in whom invasive treatment is being considered, these tests may be useful because knowing the size and shape of the prostate is helpful in determining which form of treatment may be optimal. Once a decision to proceed with TUNA is made, ultrasonography of the prostate is required to obtain prostate length and width. This is needed to determine the needle length for treatment and helps determine how many lesions are needed for treatment.
    • 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. Naslund and Stitcher, however, have done some work with TUNA in these patients, which is discussed in Outcome and Prognosis.1
    • Historically, patients with glands larger than 100 mL are thought to be candidates for open prostatectomies. However, many urologists have gained considerable expertise in safely performing TURP on patients with prostates larger than 100 mL. The decision of which surgical therapy to perform depends, to a large degree, on the individual surgeon's skill and experience with both TURP and open surgery. For those with exceptional skill, expertise, and experience with TURP surgery, open prostatectomy for benign prostatic disease may be rarely required.

Histologic Findings

Histologic studies, mainly derived via transrectal ultrasonography of the prostate and needle biopsy, are needed only in the event of an elevated PSA level or suggestive physical examination to rule out prostate cancer.

More on Transurethral Needle Ablation of the Prostate (TUNA)

Overview: Transurethral Needle Ablation of the Prostate (TUNA)
Workup: Transurethral Needle Ablation of the Prostate (TUNA)
Treatment: Transurethral Needle Ablation of the Prostate (TUNA)
Follow-up: Transurethral Needle Ablation of the Prostate (TUNA)
References
Further Reading
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References

  1. Naslund MJ, Stitcher MF. A cost comparison of TUNA vs TURP. J Urol. 1997;157 (supplement):155A.

  2. Chapple CR, Issa MM, Woo H. Transurethral needle ablation (TUNA). A critical review of radiofrequency thermal therapy in the management of benign prostatic hyperplasia. Eur Urol. Feb 1999;35(2):119-28. [Medline].

  3. Naslund MJ, Carlson AM, Williams MJ. A cost comparison of medical management and transurethral needle ablation for treatment of benign prostatic hyperplasia during a 5-year period. J Urol. Jun 2005;173(6):2090-3; discussion 2093. [Medline].

  4. Rosario DJ, Woo H, Potts KL, Cutinha PE, Hastie KJ, Chapple CR. Safety and efficacy of transurethral needle ablation of the prostate for symptomatic outlet obstruction. Br J Urol. Oct 1997;80(4):579-86. [Medline].

  5. 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. J Urol. Nov 1998;160(5):1695-700. [Medline].

  6. Rodrígo Aliaga M, López Alcina E, Monserrat Monfort JJ, Pontones Moreno JL, Valls Blasco F, Boronat Tormo F, et al. [Treatment of benign hyperplasia of the prostate using thermal transurethral needle ablation (TUNA)]. Actas Urol Esp. Jul-Aug 1997;21(7):649-54. [Medline].

  7. Millard RJ, Harewood LM, Tamaddon K. A study of the efficacy and safety of transurethral needle ablation (TUNA) treatment for benign prostatic hyperplasia. Neurourol Urodyn. 1996;15(6):619-28; discussion 628-9. [Medline].

  8. Zlotta AR, Peny MO, Matos C, Schulman CC. Transurethral needle ablation of the prostate: clinical experience in patients in urinary acute retention. Br J Urol. Mar 1996;77(3):391-7. [Medline].

  9. Schulman CC, Zlotta AR. Transurethral needle ablation of the prostate for treatment of benign prostatic hyperplasia: early clinical experience. Urology. Jan 1995;45(1):28-33. [Medline].

  10. Hill B, Belville W, Bruskewitz R, Issa M, Perez-Marrero R, Roehrborn C, et al. Transurethral needle ablation versus transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia: 5-year results of a prospective, randomized, multicenter clinical trial. J Urol. Jun 2004;171(6 Pt 1):2336-40. [Medline].

  11. Beduschi MC, Oesterling JE. Transurethral needle ablation of the prostate: a minimally invasive treatment for symptomatic benign prostatic hyperplasia. Mayo Clin Proc. Jul 1998;73(7):696-701. [Medline].

  12. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. Sep 1984;132(3):474-9. [Medline].

  13. Bouza C, Lopez T, Magro A, Navalpotro L, Amate JM. Systematic review and meta-analysis of Transurethral Needle Ablation in symptomatic Benign Prostatic Hyperplasia. BMC Urol. 2006;6:14. [Medline].

  14. Boyle P, Robertson C, Vaughan ED, Fitzpatrick JM. A meta-analysis of trials of transurethral needle ablation for treating symptomatic benign prostatic hyperplasia. BJU Int. Jul 2004;94(1):83-8. [Medline].

  15. Bruskewitz R, Issa MM, Roehrborn CG, Naslund MJ, Perez-Marrero R, Shumaker BP, et al. A prospective, randomized 1-year clinical trial comparing transurethral needle ablation to transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia. J Urol. May 1998;159(5):1588-93; discussion 1593-4. [Medline].

  16. Guess HA, Arrighi HM, Metter EJ, Fozard JL. Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate. 1990;17(3):241-6. [Medline].

  17. Lepor H. Natural History, Evaluation, and Nonsurgical Management of Benign Prostatic Hyperplasia. In: Walsh PC,Retik AB, Vaughan ED Jr, Wein AJ. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:1453-60.

  18. McConnell JD. Epidemiology, Etiology, Pathophysiology, and Diagnosis of Benign Prostatic Hyperplasia. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:1429-52.

  19. McCullogh DL. Minimally Invasive Treatment of Benign Prostatic Hyperplasia. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:1503-5.

  20. Mebust WK. Transurethral Surgery. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:1511-28.

  21. Perlmutter AP. New Uses of Energy for the Treatment of BPH. AUA Update Series. 1997;XVI:250-5.

  22. Roehrborn CG, Issa MM, Bruskewitz RC, Naslund MJ, Oesterling JE, Perez-Marrero R, et al. Transurethral needle ablation for benign prostatic hyperplasia: 12-month results of a prospective, multicenter U.S. study. Urology. Mar 1998;51(3):415-21. [Medline].

  23. Schulman CC, Zlotta AR. Transurethral needle ablation (TUNA) of the prostate: clinical experience with two years follow-up in patients with benign prostatic hyperplasia (BPH). Eur Urol. 1996;30(Suppl 2):263.

  24. Schulman CC, Zlotta AR, Rasor JS, Hourriez L, Noel JC, Edwards SD. Transurethral needle ablation (TUNA): safety, feasibility, and tolerance of a new office procedure for treatment of benign prostatic hyperplasia. Eur Urol. 1993;24(3):415-23. [Medline].

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Further Reading

For additional information, visit Medscape’s BPH Resource Center.

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Keywords

transurethral needle ablation, transurethral needle ablation of the prostate, TUNA, transurethral destruction of prostate tissue by radiofrequency thermotherapy, TUMP, prostate cancer, prostate surgery, prostate-specific antigen, prostate specific antigen, PSA, prostate needle ablation, benign prostatic hypertrophy, benign prostatic hyperplasia, BPH, prostatism, American Urologic Association Symptom Score, AUA Symptom Score, International Prostate Symptom Score, IPSS, prostatic enlargement, enlarged prostate, digital rectal examination, DRE, interstitial radiofrequency needles, interstitial RF needles, heat-induced coagulation necrosis, transurethral resection of the prostate, TURP, TUNA of the prostate, diminished uroflow, urodynamic obstruction

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Contributor Information and Disclosures

Author

Nicolas A Muruve, MD, FRCSC, FACS, Associate Staff, Department of Urology, Cleveland Clinic Florida
Nicolas A Muruve, MD, FRCSC, FACS is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, American Urological Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Keith Steinbecker, MD, Consulting Staff, Department of Urology, St John's Mercy Medical Center
Keith Steinbecker, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

T Brian Willard, MD, Consulting Staff, Department of Surgery, Division of Urology, Lexington Urological Associates
T Brian Willard, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Allen Donald Seftel, MD, Professor, Department of Urology, Case School of Medicine
Allen Donald Seftel, MD is a member of the following medical societies: Ohio State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Stephen W Leslie, MD, FACS, Founder and Medical Director of the Lorain Kidney Stone Research Center, Clinical Assistant Professor, Department of Urology, Medical College of Ohio
Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, National Kidney Foundation, and Ohio State Medical Association
Disclosure: Nothing to disclose.

 
 
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