TULSA-PRO · Prostate treatment evidence
How the TULSA procedure works: planning, treatment day and recovery
TULSA-PRO heats prostate tissue with ultrasound sent from inside the urethra, the tube that carries urine. MRI guides the treatment. After whole-gland treatment, plan on a catheter for about two weeks. Also plan for a slow return to normal urination, steps to prevent infection, and the follow-up tests you will need.
Medically reviewed by Michael O. Koch, MD · September 23, 2026 · Updated September 30, 2026
One device, several different medical questions
TULSA stands for transurethral ultrasound ablation. “Transurethral” means through the urethra. “Ablation” means destroying tissue, here with heat. A thin device goes into the urethra and sends ultrasound energy out into the prostate. MRI measures the temperature as it rises. That feedback keeps the heat inside the planned treatment area. The system also cools nearby tissue. This is different from ultrasound given through the rectum. It is also different from surgery that removes the prostate. Read the FDA device description.
What FDA clearance tells you
The FDA cleared TULSA-PRO to destroy prostate tissue. That is not the same as a claim about a disease. Clearance does not show that a given cancer will be cured. It does not show that every enlarged prostate is a good fit. It does not show better results than surgery or radiation. You need the studies for your own diagnosis for that. FDA guidance explains this difference.
Treatment is more than the time in the scanner
| Stage | What should be clear | A useful question |
|---|---|---|
| Assessment and planning | Why you are being treated. The area to be treated. Your anatomy and past treatments. How well you urinate and have sex now. | Which findings in my own records support this plan, and which could change it? |
| Treatment day | The center’s plan for anesthesia, MRI, placing the device and recovery. Which parts of the plan may change during treatment. | Who will explain the final treated area and any change from the plan? |
| Recovery and follow-up | Written catheter and medicine instructions. Who to call with problems. A follow-up schedule for your diagnosis. | Who is in charge of my follow-up if the treatment center is far from home? |
The device maker describes the procedure and its safety information. But the treatment center must give you a plan made for you. In the TACT study, the heating step took a median of 51 minutes. That is not the length of the whole visit, the anesthesia or the recovery. It is not a promise about when you can go back to work. TACT study. Manufacturer procedure information.
Expect a catheter and a recovery period
A catheter is a thin tube that drains urine from the bladder. Dr. Koch advises that most men need one for about two weeks after whole-gland TULSA. Trouble passing urine can go on after the catheter comes out. The CAPTAIN trial supports this. The typical (median) catheter time was 13 days after TULSA and 8 days after robotic prostate surgery. Most TULSA patients went home the same day, after a median stay of about 7 hours. CAPTAIN early results.
Ask your team what to expect. Ask who to call if recovery is not going as planned.
Infection also needs a clear plan. Dr. Koch notes two causes. Bacteria can already live in the bladder. And prostate tissue dies after it is heated, which can let infection set in. Ask how the team checks for infection before treatment. Ask what to do about fever, chills or worse urinary symptoms afterward. These are general points from Dr. Koch’s review. Your own team must give you personal instructions.
What can go wrong?
Serious problems are uncommon. In the TACT study, 12 of 115 men (10%) had a grade 3 side effect over five years. Grade 3 is the study’s label for a severe side effect. No man had a more severe (grade 4) event or an injury to the rectum. TACT five-year report.
The device maker lists the most common side effects as mild and short-lived. These are urinary symptoms, blood in the urine, minor infections and discomfort in the pelvis, genitals, belly or rectal area. It lists rarer, more serious risks too. These are anesthesia problems, sexual problems, urine leakage, discharge from the urethra, urinary tract infection, blood clots in the legs, injury to the rectum, and narrowing of the bladder outlet or urethra. Some of these need more treatment. Urinary symptoms can also get worse, such as needing to go more often, more urgently or at night. Read the manufacturer’s safety information.
Your risk depends on how much tissue is treated and what treatment you had before. One number does not fit everyone. Ask the center for its own results in men like you, with the same plan and the same length of follow-up. Ask how many men were counted and how each result was defined. Words like “continence,” “potency,” “retreatment” and “serious complication” can be measured in different ways. Results in men with untreated cancer do not apply to men treated after radiation.
Before you leave the treatment center
Ask your team to put these points in your discharge plan. This page cannot give you personal recovery instructions.
- Who to call in the daytime and after hours. Which symptoms need a call right away or a trip to the emergency room.
- Your catheter plan, any medicine changes, your activity limits and who can change them.
- Your first follow-up visit and which doctor gets the treatment report.
- For cancer, how PSA, imaging and biopsy will look for cancer that remains or returns. PSA is a protein measured in a blood test. A fall in PSA is not the same result as a biopsy that finds no cancer.
- What would lead to a talk about more treatment, and which choices would still be open.
The TACT study checked both PSA and a follow-up biopsy. That shows why one early number cannot tell the whole story. See the original TACT report. NCI treatment overview.
Take these questions to your care team
Modern Prostate Institute does not offer patient intake or TULSA provider matching. Talk with your own doctor or a hospital urology service about your records and options. Do not send medical records through a public contact form.
Read our care-navigation guidance →
Medically reviewed by
Michael O. Koch, MD
John P. Donohue Professor of Urology at Indiana University School of Medicine. He chaired the university’s urology department from 1998 to 2024. Dr. Koch reviewed these TULSA pages on September 23, 2026 and sent the corrections included here. He is an author of the TACT five-year and CAPTAIN reports cited on these pages.
About Dr. Koch and his review →