What are the potential side effects of transurethral ultrasound ablation of the prostate?

Side Effects of Transurethral Ultrasound Ablation of the Prostate

Transurethral ultrasound ablation (TULSA) of the prostate can cause several side effects including urinary retention, irritative voiding symptoms, erectile dysfunction, and retrograde ejaculation, though it generally has a favorable safety profile compared to traditional surgical approaches. 1

Common Side Effects

Urinary Symptoms

• Acute urinary retention: Can occur in up to 71% of patients following the procedure, typically resolving within 1-34 days (mean duration 6.3 days) 2
• Irritative voiding symptoms:
  • Urgency, dysuria, and nocturia may occur in up to 50% of patients 3
  • These symptoms are generally self-limited and respond to symptomatic treatment
  • May persist for several weeks post-procedure 2

Sexual Function Effects

• Erectile dysfunction:
  • May affect sexual function, though studies suggest the median international index of erectile function score remains relatively stable (24 to 25) over 48 months 1
  • Less common than with TURP, which affects up to 50% of men 3
• Retrograde ejaculation:
  • Can occur but appears less common than with TURP 3
  • Reported in approximately 22% of sexually active men (13 of 58) in studies of similar ultrasound-guided procedures 4

Pain

• Perineal pain: Noted by approximately half of patients during the first 1-2 weeks post-procedure 2
• Analgesics: Frequently required to manage post-procedure pain 2

Less Common Side Effects

Complications

• Grade 1 and 2 complications: May occur in some patients but typically resolve within 4 weeks 1
• Grade 3 adverse events: Occur in a small percentage of patients and typically resolve within 3 months 1
• Bleeding: Generally minimal compared to TURP, with significantly reduced transfusion rates 5, 4
• Urethral trauma: Risk is lower than with chronic indwelling urethral catheters but should be monitored 3

Long-term Issues

• Need for retreatment: Some patients may require subsequent procedures due to insufficient improvement 4
• Urethral stricture: Less common than with TURP (which has rates of 2.2-9.8%) 5
• Bladder neck contracture: Less common than with TURP (which has rates of 0.3-9.2%) 5

Advantages Over Traditional Procedures

• No TURP syndrome: The dilutional hyponatremia that can occur with TURP is not seen with TULSA 5, 4
• Reduced bleeding risk: Significantly lower than TURP, with minimal to no transfusion requirements 4
• Outpatient procedure: Can often be performed as a day case or office procedure 6
• Preservation of continence: Pad-free continence preserved in 96% of patients in recent studies 1

Monitoring and Management

• Patients should be counseled about the potential for temporary urinary retention and the possible need for catheterization
• Regular follow-up is recommended to detect and address any complications
• Pain management should be discussed pre-procedure, with appropriate analgesics prescribed
• Patients should be informed that improvement in symptoms may take longer compared to traditional TURP 4

TULSA represents a promising minimally invasive alternative to traditional surgical approaches for prostate conditions, with a generally favorable side effect profile, though patients should be fully informed about potential complications and the expected recovery process.