Transurethral Needle Ablation of the Prostate - Procedure, Indications, Contraindications, Benefits, and Complications

What Is a Transurethral Needle Ablation of the Prostate?

Transurethral needle ablation of the prostate gland is a treatment procedure used in the case of benign prostatic hyperplasia. The prostate gland is one of the most important parts of the male reproductive system. It is located in front of the rectum (the organ that holds stools) near the neck of the urinary bladder (the organ that stores urine). The gland is about the size of a walnut and weighs 20 grams. The main function of the prostate gland is to produce the fluid (semen) that allows the transport and the growth of the sperms. Enlargement of the prostate gland is most commonly seen in old age. As a result, the urine flow gets obstructed, and the patient experiences pain and a burning sensation while passing urine. In the transurethral needle ablation procedure, the part of the prostate that obstructs the urethra is destroyed with the help of radio waves. It is a minimally invasive procedure, so the patient experiences less trouble during the surgery.

Why Is Transurethral Needle Ablation Done?

Transurethral needle ablation needs to be done for patients suffering from benign prostatic hyperplasia. It is a condition in which the prostate gland becomes enlarged. As the prostate gland is present near the urinary bladder, the patient presents with problems in the urinary system. If the patient is unwilling to undergo surgery and other recommended treatment options, transurethral needle ablation needs to be done. So, the patient whose gland is 60 grams or less, and presents with the following symptoms, needs to undergo transurethral needle ablation:

1. Urinary incontinence or leakage of urine during the day and night.

2. Hematuria, or the presence of blood in the urine, is seen.

3. Urinary tract infections and bladder infections occur repeatedly.

4. The urine does not flow even after a strong urge to urinate.

5. The patient urinates more than eight to ten times per day.

6. Nocturia, or the feeling of urinating at night.

7. Pain and a burning sensation while passing urine.

8. Difficulty in starting the flow of urine.

What Are the Contraindications of Transurethral Needle Ablation?

The transurethral needle ablation should not be performed under the following circumstances:

• At the time of urinary tract infections, the procedure should not be done as the risk of sepsis increases.

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• The person has a neurogenic bladder, a condition wherein control over the urinary bladder is lost.

• Narrowing of the urethra or urethral stricture makes the insertion of the instrument difficult.

• A patient who will be unable to survive the next 24 hours without surgery.

• Patients on anticoagulants should not undergo the procedure as it increases the risk of bleeding. The drugs need to be stopped ten days before surgery.

• Prostate cancer or urinary bladder cancer has been diagnosed clinically and radiographically.

• The length of the prostate gland is less than 34 millimeters.

• Patients who have undergone prostatic therapy previously.

• Presence of penile implants and cardiac pacemakers.

How Is the Procedure of Transurethral Needle Ablation Performed?

Transurethral needle ablation is mainly recommended for patients who do not wish to undergo prostate surgery. It is a minimally invasive procedure wherein the affected part of the gland is heated. The heated part is either absorbed by the body or passes through the urine. Before the procedure is carried out, a transurethral ultrasound is done. The procedure of transrectal ultrasound has been described below:

• Transrectal Ultrasound - In this procedure, the patient is laid on a table, and a device known as a transducer is mainly used to obtain the images of the rectum. The transducer is inserted into the rectum, and the sound waves are sent to the body. When these waves bounce back from the rectum, the images are obtained on the computer screen. The ultrasound is done to know about the length, and width of the prostate gland, the length up to which the needle is to be inserted, and the number of lesions that need to be treated.

After the transrectal ultrasound is done, the steps to be followed in the procedure are listed below:

• The patient needs to urinate before the procedure, and the urine has to be sterile, that is, free from bacteria. If the urine contains bacteria, antibiotics need to be administered for the same.

• The patient is placed in a position where he lies on the back, and his legs are elevated at 90 degrees. This position has been named the lithotomy position. It is the most preferred one when any operative procedure is carried out in the lower abdominal region.

• The patient is conscious and aware of his surroundings because the procedure need not be done under general anesthesia.

• Valium or Demerol is administered orally to relax the patient. A gel might be applied to the urethra before the insertion of the needle.

• Local anesthesia is injected with the help of ultrasound at the site so that the patient does not feel pain.

• A telescope-like instrument known as the endoscope is inserted into the urethra to reach the prostate gland.

• The endoscope contains light, a camera, and two needles attached at the end. The needles are covered by the sheaths that control the length of exposure. Also, there are sensors present in the needle sheath to control the temperature of the prostate gland and the surrounding areas.

• Once the prostate gland has been located with the help of the endoscope, the needles send radio waves to the tissues of the prostate gland.

• The radio waves get transferred in the form of electrical energy. As the prostate gland resists the passage of current, heat energy is produced due to friction and the heating of water molecules present between the cells.

• The heat produced destroys the tissues of the prostate gland that are in excess. The entire procedure is repeated four to eight times, and the excessive cells are completely removed.

• After the cells have been removed, a tube known as a catheter is inserted to facilitate the drainage of urine. The catheter is left in place for one to three days as the patient will be unable to urinate normally after the procedure.

• The patient needs to continue with the antibiotics for three to five days after the procedure is complete.

What Happens After the Procedure?

The patient needs to pass urine through the catheter for a few days. However, he can return to work and normal activities after four to six weeks as that is the time required for healing. The patient might experience the following after the treatment, but that is normal:

1. Hematuria, or the presence of blood in the urine, is common.

2. A strong urge to urinate in the middle of the night.

3. Pain and burning sensation while urinating.

4. The urine might leak out before reaching the toilet (urinary incontinence).

The patient needs to keep in mind the following things after the treatment:

1. Drink a sufficient quantity of water daily to maintain the fluid and electrolyte levels.

2. Avoid lifting heavy objects or weights.

3. Have a fiber-rich diet to prevent constipation.

4. The patient might suffer from retrograde ejaculation. It means the semen leaves the body through the urinary bladder and not through the urethra.

5. The medications should be taken only after consultation with the doctor.

What Are the Benefits of the Procedure?

Transurethral needle ablation has many advantages, and the patients prefer to undergo this procedure as it saves them from the trauma of surgery. The benefits of the procedure have been listed below:

• The risk of bleeding is very low, so the patients on anticoagulant therapy need not worry. They can undergo the procedure easily without severe bleeding.

• There is no need to stay in the hospital for long, as the discharge is done on the same day. The healing gets completed in four to six weeks.

• The procedure is carried out under local anesthesia, so the patient is aware of his surroundings.

What Are the Complications of the Procedure?

Transurethral needle ablation is a safe procedure, but the patients might present with the following complications:

1. Pain and a burning sensation while urinating due to inflammation of the prostate gland.

2. Difficulty while urinating.

3. Urinary tract infections repeatedly occur because the bacteria reach the urinary system through the catheter.

4. The penis might not remain erect at the time of intercourse, leading to erectile dysfunction.

5. The patient might need to undergo the procedure again if the condition recurs.

Conclusion:

Transurethral needle ablation is done to treat the enlargement of the prostate gland. It is done with the help of a telescope-like instrument known as the endoscope. The doctor does not have to put his hands inside the body to complete the procedure, unlike others. Enlargement of the prostate gland or benign prostatic hyperplasia is a common problem in elderly males. As the gland is located close to the bladder, enlargement of it can block the urine flow. Transurethral needle ablation aims to remove the tissues of the gland that are present in excess. Low-frequency radio waves are passed to the gland by the needles, and the tissues are destroyed. This procedure is a boon for the patients reluctant to undergo surgery because it does not require them to stay in bed for long. They can resume their normal activities as soon as the healing is complete.