MRI-guided transurethral ultrasound ablation
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Revision as of 14:29, 18 December 2025 by Tony Wang (talk | contribs) (Tony.Wang moved page MRI-guided transurethral urethral ultrasound ablation to MRI-guided transurethral ultrasound ablation without leaving a redirect: Typo)
MRI-guided transurethral ultrasound ablation
| Anesthesia type |
General |
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| Airway |
ETT |
| Lines and access |
PIV |
| Monitors |
Standard ASA |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
Paralysis to maintain akinesis for image guidance |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
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
- Prostate cancer
- BPH
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
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Maintenance and surgical considerations
Maintain paralysis for MRI image guidance precision. Consider rocuronium/vecuronium infusion.
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
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| Unique considerations | ||
| Indications | ||
| Position | ||
| Surgical time | ||
| EBL | ||
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References
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