Transurethral ultrasound ablation (TULSA) is a minimally invasive procedure used to treat prostate conditions, especially prostate cancer that has not spread beyond the prostate. TULSA uses ultrasound energy, guided by magnetic resonance imaging (MRI), to heat and destroy targeted prostate tissue while sparing nearby structures. This approach aims to destroy cancerous prostate tissue or relieve symptoms while reducing side effects compared with traditional surgery or radiation. Many people have no evidence of cancer on follow-up tests, and bladder control and the ability to have erections are often preserved or return after TULSA.

TULSA is a medical procedure that uses ultrasound energy, or high-frequency sound waves, delivered through the urethra, the tube that carries urine out of the body, to heat and destroy prostate tissue. The procedure is guided by real-time magnetic resonance imaging (MRI), which produces detailed images of the prostate and allows doctors to monitor the temperature and precisely target the area to be treated.

A special device called an ultrasound applicator is inserted into the urethra. The applicator has several independently controlled sections that direct ultrasound energy into the prostate. They can be adjusted to treat the whole prostate gland or a specific area. Cooling devices are also used to protect the urethra and rectum from heat damage during the procedure.

TULSA may be used to treat prostate cancer that has not spread beyond the prostate, prostate enlargement that causes urinary problems, or advanced prostate cancer that causes difficulty urinating or blood in the urine. It may also be used when prostate cancer has returned after other treatments or when other treatments are unsuitable because of health reasons or patient preference.

TULSA is most often considered for people whose prostate cancer has a low or intermediate risk of growing or spreading, based on test results assessed by their medical team, and who want an alternative to traditional surgery or radiation, which can have significant side effects. It may also be used to treat benign prostatic hyperplasia (BPH), an enlargement of the prostate that is not caused by cancer, when it causes bothersome urinary symptoms.

Good candidates for TULSA generally meet certain health and prostate size criteria. Other factors include:

• A prostate gland within the device’s size limits
• No large calcifications or cysts in the prostate because these can block the ultrasound energy
• No evidence of cancer very close to the muscle that controls urine flow or the area where the bladder narrows into the urethra, because treating these areas could increase the risk of complications
• The ability to undergo MRI scans and general anesthesia safely
• No active infections or other serious health problems that would make the procedure risky

People who have had previous prostate treatments may also be considered, especially if other options are limited. The medical team decides whether TULSA is appropriate after a careful evaluation.

Several medical tests are needed before TULSA to ensure the procedure is safe and appropriate. These tests help doctors assess the prostate, check for cancer spread, and identify factors that could affect treatment.

• Prostate-specific antigen (PSA) blood test: Measures a protein linked to prostate health and helps assess cancer risk.
• Multiparametric MRI scan: Provides detailed images of the prostate to locate tumors and identify the treatment area.
• Prostate biopsy: Involves taking small tissue samples from the prostate to determine whether cancer is present and, if so, what type it is.
• Imaging for calcifications or cysts: Uses MRI or sometimes computed tomography (CT) scans to detect hard deposits or cysts that could interfere with the ultrasound energy.
• General health assessment: Includes blood tests and a review of medical history to check for infections or other conditions that might affect anesthesia or recovery.

Preparation for TULSA involves several steps to ensure safety and the best possible outcome. Before the procedure, doctors will review the patient’s medical history, perform necessary tests, and discuss anesthesia plans.

• Fasting: People are usually asked not to eat or drink for several hours before the procedure because general anesthesia is used.
• Medication review: Doctors may adjust or pause certain medicines, such as blood thinners, to reduce bleeding risk.
• Bladder preparation: A urinary catheter is placed to empty the bladder and help with device placement during and after the procedure.
• Bowel preparation: Instructions may be given to empty the bowel before the procedure and usually include an enema. This helps with the placement of the cooling device and improves imaging.
• Infection prevention: Antibiotics are often given before and after the procedure to lower the risk of urinary tract infections (UTIs).

During TULSA, the patient receives general anesthesia and is positioned for the procedure inside an MRI scanner. The process involves several carefully controlled steps.

First, a special ultrasound applicator is inserted into the urethra, and a cooling device is placed in the rectum to protect nearby tissue from heat. A robotic system holds the applicator in place and allows for precise movement and positioning. MRI images confirm that both devices are positioned correctly.

Next, the doctor uses MRI images to plan the treatment area by outlining the exact part of the prostate to be treated. The software helps ensure that important structures are avoided or protected.

Once planning is complete, the ultrasound applicator delivers controlled sound waves to heat the targeted prostate tissue. MRI images taken continuously during the procedure show temperature changes, allowing the system to monitor the heat and guide the treatment. The system automatically adjusts the power and direction of the ultrasound to heat the entire treatment area to the intended temperature while avoiding overheating nearby tissue.

The ablation process usually takes about 50 minutes, but the total time in the MRI suite, including preparation and recovery, can be several hours. After treatment, MRI images confirm that the targeted tissue has been treated. A urinary catheter is placed and typically remains in place for about one week to help with urination during early recovery.

The risks and possible complications of TULSA are generally lower than those of traditional prostate surgery and radiation therapy, but some problems can still occur. Most side effects are temporary and resolve within a few months, but some may last longer or require additional treatment.

• Urinary tract infection: An infection of the bladder or urinary tract can occur and is usually treated with antibiotics
• Urinary retention: Difficulty emptying the bladder may occur and sometimes requires a catheter for a short period
• Urinary incontinence: Some people may experience urine leakage, but most regain control within a few months
• Urethral stricture: The urinary passage may narrow and sometimes requires a minor procedure to correct it
• Pain or discomfort: Pelvic or urinary discomfort is common during the first few days after the procedure
• Blood in the urine: Mild bleeding may cause blood in the urine but usually goes away on its own
• Epididymitis: Inflammation of the tube behind the testicle can occur and may require antibiotics
• Rare complications: Uncommon serious problems include severe infection, urinoma, which is a collection of urine outside the urinary tract, or deep vein thrombosis, which is a blood clot in a deep vein
• Erectile dysfunction: Problems with erections can occur, but many people retain or regain the ability to have erections over time

Recovery after TULSA is usually faster and less painful than recovery after traditional prostate surgery. Most people go home the same day. A urinary catheter is typically left in place for about one week, and normal urination usually returns soon after it is removed.

An urgent or frequent need to urinate and discomfort during urination are common during the first few weeks but tend to improve over time. Bladder control and the ability to have erections may worsen temporarily but often return to their pretreatment levels within three to six months. Most people can return to normal activities within a few days, but strenuous exercise and sexual activity may need to be avoided for a short period as advised by the care team.

The outlook for people who undergo TULSA is generally positive. Most people with prostate cancer who undergo TULSA experience a significant drop in PSA levels, and many have no evidence of cancer on follow-up tests. Studies show that about 80% of people have no cancer detected on follow-up tests 12 months after TULSA.

The risk of severe complications is low, and quality of life is usually maintained or improved compared with traditional treatments.

“Our center was among the earliest in North America to offer TULSA, and we have years of experience treating patients with it,” says Preston Sprenkle, MD, a Yale Medicine urologist who specializes in the treatment of urologic cancers, including prostate cancer, kidney cancer, bladder cancer, testicular cancer, and sarcoma. “You’ll be evaluated by a team of radiologists and urologists, including specialists who have performed prostate cancer ablation for more than a decade. Because we offer more than one ablation technology, we can recommend the option that best fits you rather than trying to make one technique work for everyone.”

This article was medically reviewed in September 2026.