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Continuing Education
Transurethral needle ablation is a minimally invasive treatment for benign prostatic hyperplasia. The procedure, with emphasis on patient selection, preoperative preparation, nursing role during the treatment, as well as postoperative care and assessment, is discussed.
Transurethral needle ablation (TUNA) of the prostate is a minimally invasive procedure for treating benign prostatic hyper-- plasia (BPH). It is an FDA-- approved modality and now Medicare reimbursable in all states as an office or clinic procedure. Implementing the procedure in the office setting requires thorough training of the nursing staff to provide for a successful and safe treatment. The purpose of this article is to provide an overview of the nursing role in patient care of those undergoing a TUNA procedure. The content is based on the experiences at one institution that treated approximately 30 patients in the past year. Other sites may adapt the general principles outlined here to meet their own circumstances.
What Is TUNA?
Transurethral needle ablation is a BPH treatment option, which uses radio-frequency (RF) waves to create thermal effects inside the prostate gland. It is based on the principle that heating the adenoma causes necrosis of obstructing tissue and leads to relief of prostatic obstruction (Naslund, 1997). The RF signal is carried into the prostate via needle electrodes. The length of the needles, which is set individually for each patient's prostate size, energy wattage, and duration of treatment determine the amount of thermal ablation. It allows tissue ablation to occur only in the region directly targeted while preserving adjacent tissues and organs, especially the urethra and rectum (Issa, Myrick, & Symbas, 1998a & b).
Urethral preservation is a significant benefit of TUNA. The procedure avoids destruction of the urethra, which is a painful component of other techniques that precludes treatment under local anesthesia in a clinic setting. In addition, it decreases postoperative morbidity of hematuria, urinary retention, tissue sloughing, and retrograde ejaculation (Issa et al., 1998a & b). After a TUNA procedure, the necrotic tissue subsequently undergoes absorption, contraction, and scar formation over the ensuing 8 weeks (Naslund, 1997).
Equipment
The equipment used at our site is the Precision TUNA system by VidaMed, Inc. It is portable and fits well on a Lakeside cart (see Figure 1). It consists...