Anaesthetic management of magnetic resonance imaging-guided transurethral ultrasound ablation of the prostate of a patient with prostatic adenocarcinoma.

Transurethral ultrasound ablation (TULSA) of the prostate is an innovative, minimally invasive, incision- and radiation-free procedure guided by MRI. Early clinical data suggest TULSA is associated with lower rates of common postoperative complications including urinary incontinence and erectile dysfunction. Its minimally invasive profile makes it especially suitable for elderly patients and those with elevated medico-surgical risks. We report the anaesthetic management of the first MRI-guided TULSA procedure performed in Southeast Asia on an elderly male patient in his 80s with prostatic adenocarcinoma. General anaesthesia was administered using a balanced technique combining low-dose volatile agent with continuous infusions of remifentanil and rocuronium. This approach ensured stable haemodynamics, adequate sedation and complete immobility throughout the procedure. To date, there are no established anaesthetic protocols for TULSA. Our experience demonstrates that the essential goals of immobility, sedation and rapid recovery can be effectively achieved.