View source for MRI-guided transurethral ultrasound ablation

{{Infobox surgical procedure
| anesthesia_type =General 
| airway =ETT 
| lines_access =PIV 
| monitors =Standard ASA 
| considerations_preoperative = 
| considerations_intraoperative =Paralysis to maintain akinesis for image guidance 
| considerations_postoperative = 
}}'''MRI-guided Transurethral Ultrasound Ablation (TULSA)''' is a minimally invasive, incision-free procedure used to treat prostate cancer and enlarged prostate (BPH). It uses high-frequency sound waves to generate heat and destroy targeted prostate tissue from the "inside out."

The procedure is commonly referred to by its commercial name, '''TULSA-PRO.'''

==Overview==
===Indications<!-- List and/or describe the indications for this surgical procedure. -->===

* Prostate cancer
* BPH

===Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. -->===

* '''The Device:''' A thin, rod-shaped device is inserted into the urethra while the patient is under GA.
* '''MRI Guidance:''' The entire procedure takes place inside an MRI scanner. This allows the surgeon to see the prostate in high-definition and map out exactly which tissue needs to be destroyed and which should be saved.
* '''The Ablation:''' The device emits directional ultrasound waves that heat the prostate tissue to about 55°C–60°C (131°F–140°F), which kills the cancerous or excess cells.
* '''Real-Time Cooling:''' While the ultrasound heats the prostate, the device circulates cool water to protect the walls of the urethra and the rectum.
* '''Precision Monitoring:''' The MRI provides real-time "heat maps," allowing the doctor to adjust the intensity and direction of the ultrasound every few seconds to ensure the heat stays within the treatment boundary.

==Preoperative management==
===Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->===
{| class="wikitable"
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===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->===
===Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->===
===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===
===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===

==Intraoperative management==
===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->===

===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===

===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===

===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===
Maintain paralysis for MRI image guidance precision. Consider rocuronium/vecuronium infusion.

===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===

==Postoperative management==
===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->===

===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->===

===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===

==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->==

{| class="wikitable wikitable-horizontal-scroll"
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|EBL
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==References==

[[Category:Surgical procedures]]