Benign prostatic hyperplasia and tulsa procedure

According to a study done by BJU International, TULSA appears to be safe and effective for treating lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). In this article, we discuss some of the findings of the research and how the TULSA Procedure works.

What is BPH?

Benign prostatic hyperplasia (BPH) is a condition in which the prostate gland is enlarged, causing symptoms such as blocked urine flow, uncomfortable or painful urination, urinary tract problems, bladder complications, and kidney issues. BPH is most common amongst older men, affecting approximately 50% of men ages 51-60 and up to 90% of men over 80 years old.

While the cause of BPH is not officially confirmed, research has shown that age is a contributing factor. The amount of testosterone in men decreases with age, leaving a higher amount of estrogen which promotes cell growth in the prostate. Another possible link is due to the male hormone called dihydrotestosterone (DHT). Males who produce DHT are more likely to be diagnosed with BPH than those who don’t produce the hormone.

The Results of MRI-Guided Ablation For BPH

The phase 1 study, published in BJU Journal involved treating 10 men with BPH-related LUTS. At baseline:

  • The men needed surgical intervention
  • Median age was 68 years old with a range of 63-72
  • Median prostate volume was 53ml
  • 4 patients had severe symptoms
  • 6 patients had moderate symptoms
  • 9 patients were receiving BPO (benign prostatic obstruction) medication

Researchers followed up at 3 months and 12 months, looking at uroflowmetry, prostate-specific antigen (PSA) data, and asking patients to complete functional questionnaires including the International Prostate Symptom Score (IPSS), Expanded Prostate Cancer Index Composite (EPIC-26), and International Index of Erectile Function (IIEF-5).

With MRI-guided ablation, the findings were quite remarkable at the 12 month follow up:

  • An 82% improvement in IPSS among the 10 enrolled patients
  • 101% improvement in median Qmax
  • 33% median reduction in prostate volume
  • 48% median reduction in PSA
  • No changes in continence, erectile function, bowel function, or sexual function
  • No harm with the MRI-guided ablation procedure

How the TULSA Procedure Works

The TULSA Procedure is an incision-free, MRI-guided procedure that ablates the diseased prostate tissue from the inside-out, helping to spare damage to the surrounding critical structures and subsequently, minimizing the risk of post-treatment side effects.

During the planning phase, your physician carefully ‘maps out’ the direction of the ultrasound energy which ensures that the heat does not get too close to the prostate walls and surrounding structures. The planned course is extremely precise, with meticulous accuracy down to the millimeter.

The procedure itself involves inserting a device into the urethra which rotates to create a sweeping, directional heating pattern. The ultrasound energy travels outwards towards the edge of the targeted prostate region, ablating prostate tissue using an ‘inside-out’ approach.

This procedure is physician-planned and robotically delivered, performed within an MRI suite using real-time imaging to ensure that it is done in a controlled, safe, and predictable manner. Physicians have visibility to the anatomical structure in real-time.

The technology uses closed-loop feedback which auto adjust the energy delivered to the desired temperature – helps to increase efficacy. To preserve the patients’ natural functions, the Endorectal cooling device protects the rectum, whereas the UA cooling protects the urethra. surrounding tissues and the urethra.

Take the BPH Quiz

The BPH Quiz is is a symptom severity assessment used by physicians. While it’s not intended to provide a diagnosis, it can be a great starting point for a conversation with your physician about BPH and whether the TULSA procedure is right for you.


  1. Viitala A, Anttinen M, Wright C, et al. MRI-guided transurethral ultrasound ablation for BPH: 12-month clinical outcomes of a phase I study [published online ahead of print June 23, 2021]. BJU Int. doi: 10.1111/bju.15523

Oct 20, 2021 | TULSA Procedure

Stay informed

Get the latest tips for all ages and stages. Subscribe to our newsletter.

Newsletter sign up