TULSA-PRO expands options for benign prostate hyperplasia

Benign prostatic hyperplasia (BPH) is common, and many men manage it well with medication. For those who can't tolerate medications and want to avoid traditional surgery, TULSA-PRO® offers another option.

WellSpan Health has used this MRI-guided technology for prostate cancer since 2022 — one of the first half-dozen sites in the U.S. to adopt it — and now offers it for BPH. We remain the only center in Pennsylvania providing TULSA-PRO for any indication.

In the Q&A below, Adnaan S. Moin, MD, an interventional radiologist who leads the TULSA-PRO program at WellSpan York Hospital, explains how the technology helps BPH patients.

What is TULSA-PRO and how does it work for BPH?

TULSA-PRO stands for transurethral ultrasound ablation of the prostate. We place the device through the urethra, where it uses directional ultrasound — guided by real-time MRI — to heat and ablate prostate tissue from the inside out.

For BPH, we focus the heat on the specific nodules causing urinary symptoms while preserving the nerve bundles, ejaculatory ducts and other structures that affect erectile function, continence and ejaculation.

The procedure is outpatient and performed under general anesthesia in the MRI room. It typically lasts two to four hours depending on prostate size. Patients go home the same day with a Foley catheter, which stays in place for seven to 14 days while tissue heals.

What sets TULSA-PRO apart from other BPH treatments?

Several factors make TULSA-PRO a strong fit for the right BPH patients:

• Real-time MRI guidance. No other BPH treatment offers this precision. We can see exactly which tissue is causing obstruction and target that area, preserving structures that affect sexual function and continence.
• Option for men with larger prostates. Other minimally invasive treatments are generally limited to prostate glands of about 80 grams or smaller. TULSA-PRO has no such limit, making it effective with glands up to 200 grams.
• Negligible bleeding. Because we cauterize tissue as we ablate, post-procedure bleeding is minimal — a meaningful difference from other treatment options.
• Repeatable procedure. Patients can have the TULSA-PRO procedure again if symptoms recur, unlike certain other treatments.

Which patients should I consider referring?

Consider discussing TULSA-PRO when a patient's International Prostate Symptom Score (IPSS) is above 8 and BPH is affecting their quality of life. For patients whose medications aren’t working well or who want to avoid surgery, TULSA-PRO can offer another path forward.

TULSA-PRO works particularly well for patients who:

• Have larger prostate glands that exceed the size limits of other minimally invasive options
• Want to preserve sexual function or avoid retrograde ejaculation
• Are on anticoagulants or have bleeding risk concerns
• Prefer an outpatient procedure to traditional surgery with a hospital stay

We work closely with urology across the WellSpan Health system, so if TULSA-PRO isn't the right fit for your patient, we'll quickly connect them with an appropriate physician.

Who might not be a candidate?

Patients who can't undergo MRI — those with pacemakers or certain hip replacements that distort imaging — aren't candidates. Patients who have a prior UroLift implant would need to have it removed before TULSA-PRO. We're happy to evaluate patients individually to assess candidacy.

What workup is helpful before referral?

A prostate MRI is helpful but not required — we can arrange one if needed. It's also useful to know the patient's IPSS score, medication history including side effects or poor response, prior procedures and anticoagulation status.

What outcomes can patients expect?

Our goal is to reduce IPSS scores below 8 while preserving baseline sexual function. We haven’t yet treated a BPH-only case at WellSpan Health, but our prostate cancer experience and published BPH studies support TULSA-PRO as a growing ablation option for BPH.

In a phase II study from Finland, median IPSS improved from 17 to 4 at 12 months, prostate volume decreased from 52 to 32 mL, and 96% of patients were pad-free.

In our 93 prostate cancer cases, we’ve seen an approximately 2% urethral stricture rate and one case of prolonged urinary incontinence. I tell patients I’m cautiously optimistic that they’ll reach their new normal by six months, although everyone heals at a different rate.

Why refer to WellSpan Health?

WellSpan Health brings several years of TULSA-PRO experience, an established multidisciplinary team and the distinction of being the only center in Pennsylvania offering the treatment. The team at WellSpan York Hospital includes two interventional radiologists, three nurse practitioners and a dedicated nurse coordinator who guides every patient through pre- and post-procedure care.

We've designed the experience to be straightforward for referring physicians and patients alike, keeping you updated along the way. We do procedures every other Monday and follow-up appointments at three, six and 12 months. Your patients can do their follow-ups by phone — a real convenience for those traveling from a distance.