In TURP, the obstructing part of the prostate gland is removed using a special instrument called the resectoscope that is inserted via the urinary passage.
This procedure is done under General Anesthesia or Regional Anesthesia. The amount of prostate tissue removed will depend on the size of the prostate gland. This is an in-patient procedure with an average length of stay of 3 days.
With the introduction of a new PlasmaKinetic Bipolar technology, TURP can be done as a day surgery case.
Indications for TURP:
- Acute / Chronic Urinary Retention-
- Recurrent urinary tract infections
- Haematuria (Blood in the urine)
- Bladder stone
- Renal insufficiency
- Bladder diverticulum/diverticula
- Failed medical therapy
- Patient preference
Transurethral Needle Ablation (TUNA)
For years, surgery - TURP (transurethral resection of the prostate) has been the gold standard for treating obstructive BPH. Patients with mild or moderate symptoms can choose to be on medication to relieve the symptoms. Medication can be expensive and not all patients on medication experience significant voiding improvements.
NUH is now offering a minimally invasive procedure that can be performed under local anaesthesia – Transurethral Needle Ablation of Prostate Gland (TUNA). To date, about 100 patients have successfully undergone the procedure.
TUNA has been practised widely in the United States in recent years and it has been demonstrated to be safe and effective in relieving the symptoms of BPH with good clinical outcome at 5-year follow up.
Using radiofrequency waves, two needles are inserted into the prostate. The heat generated causes the prostate gland to shrink.
The procedure takes 20-30 mins. Patients will be discharged a few hours later with a urinary catheter (i.e. to have a tube inserted into the urinary bladder to drain the urine).
So far, all our patients were discharged on the same day and their urinary catheter were removed within three to five days after the procedure.
Who is suitable for TUNA?
Patients with mild or moderate bladder obstructive symptoms who:
- Are not able to tolerate the side effects of medication (which can include giddiness, lethargy and transient drop in blood pressure)
- Do not wish to continue with long term medical therapy because of cost consideration
* Please note that patients who have prostate cancer and conditions like bladder stone, recurrent urinary tract infections, are not eligible for TUNA.
The main difference between TUNA and TURP
- Can be done under local anaesthesia
- Shorter procedure time
- Lower risk of complications (e.g. incontinence, retrograde ejaculation)
- Less invasive with minimal blood loss
Our experience with TUNA
Our experience with TUNA has shown it to be a safe clinic based procedure. Patients treated with TUNA have shown statistically significant symptomatic relief from bothersome symptoms. We know from experience that not all patients on medication experience significant voiding improvements. Some men face undesirable side effects and prefer a different management rather than remaining on long-term medication. TUNA fills a void between medical therapy and TURP by being a compromise between the limited efficacy of drug treatment and the invasiveness of surgery.
While TUNA may not necessarily reach the same efficacy as TURP, it has the advantages of low treatment related morbidity. It is not for TUNA to compete with medical treatment or TURP but rather to include it as one of the treatment options for suitable patients with enlarged prostate. We proposed TUNA as a second line treatment when medical therapy fails to improve a patient’s obstructive and irritative symptoms. In addition, TUNA can be considered for patients who wish to avoid surgical treatment or who are not fit for surgery. It can be also proposed to patients who wish a rapid treatment in an outpatient management or wish a preserved sexual function.