Minimally Invasive Surgical Therapy for BPH (MIST)

There are two procedures done in the office that work well in this category.

TUNA (Transurethral Needle Ablation of the prostate).


Use of minimally invasive surgical treatments (MISTs) for BPH has increased tremendously in the past decade for the following reasons:

  • Minimally invasive BPH treatments can be performed in a doctor’s office
  • Advantages of these therapies include less pain and faster recovery
  • Much lower incidence of post operative bleeding and sexual dysfunction, compared with TURP or laser vaporization
  • It can be done mostly under local anesthesia or IV sedation, depending on patient preference and medical condition
  • Much lower incidence of retrograde ejaculation (where no fluid or semen comes out at time of ejaculation)

TUNA – The prostate tissue is destroyed with heat delivered by low-energy radiofrequency through needles. The instrument is inserted into the prostate through the urethra and the needles are directed to the areas of enlargement. Studies have shown good results that have lasted five years or more.

The whole procedure will take approximately 30 minutes to complete. Gradually, the body will reabsorb the area of treatment and the prostate will shrink. This could take up to about six to eight weeks. The patient will go home with a catheter that stays in for one to two days and then he can either comeback to the office to have it removed or he can remove it himself at home.

Because of the radiofrequency used with the procedure, it cannot be done in patients with pacemakers.

Website for TUNA info:

UroLift – Staples are placed in the prostate to pull the tissue apart, enlarging the opening for urination. Half of the patients will not need a catheter after the procedure. Usually two staples are used for each side, totaling four staples for the whole procedure.

Website for Urolift info:

If you decide to have either of these procedures, below are frequently asked questions

What Do I Need To Do Before The Procedure? And Day Of Procedure?

  • Arrange transportation to and from treatment facility
  • Nothing to eat or drink two hours prior except for medications
  • Wear loose fitting clothing the day of procedure, because you may be going home with a catheter
  • Shower the morning of the appointment
  • Let your physician know if you are taking any blood thinners. We may ask you to hold off for a few days
  • Begin antibiotic medication two hours prior to procedure with small sip of water
  • Minimize alcohol and tobacco use 48 hours prior to procedure
  • Expect your visit to last 45-60 minutes, which includes preparation time, the procedure, and post procedure care

Average actual treatment time is 20 to 30 minutes.

What Will Happen During The Procedure?

Local anesthesia is initiated first. Anesthesia is injected around the prostate using an ultrasound probe passed transrectal. At that time the prostate is measured as well. Additional liquid anesthesia is passed through the urethra (penis tip). This is left for about 20 minutes before passage of the instrument.

You may also be given sedative pill and antibiotics to take prior.

Patients may go home with a Foley catheter connected to a leg bag for one to two days.

What Are The Benefits Of TUNA or Urolift Procedure?

  • A procedure that takes less than an hour (with some additional preparation and recovery time required)
  • Can be performed right in your Doctor’s office
  • This allows you to return to many of your normal activities within a few days
  • Few side effects and adverse events when compared to traditional surgical treatment
  • No reports of incontinence
  • Rare reports of impotence
  • Improvement within two to six weeks, depending on which treatment used
  • Five-year durability