Transrectal High-Intensity Focused Ultrasound Treatment of Benign Prostate Hyperplasia:Two Years' Experience in West-Garden Hospital

OBJECTIVE: Experimental studies have shown clear damage to prostate tissue when ex-posed to high-intensity focused ultrasound, but different results of in vivo effects have been reported by many centers. We study the safety and efficacy of HIFU in benign prostatic hyperplasia patients in Taiwan using a modified Sonablate-200 device. MATERIAL AND METHODS: From March 1999 to April 2001, a total of 121 patients suffering from symptomatic BPH received transrectal HIFU treatment under regional anesthesia with the Sonablate-200 device. Thirty-two patients who completed the treatment were withdrawn from the data analysis for various reasons, including large glands and presence of previously undetected stricture, bladder stone, intravesicle tissue bulging, and malignant disease. Eighty-nine patients were eligible for the study. Data of the International Prostate Symptom Score, quality of life, peak flow rate, post-void residual volume, and serum PSA level were collected before and after treatment at regular time intervals. A transrectal prostate sonogram was performed in all cases before treatment, and in the frist 22 cases at 9 months after treatment. The mean follow-up period was 10.11±6.24(3 to 24) months. RESULTS: Data from 40 patients with complete 12-month follow-up were analyzed. Mean peak flow rate increased from 40 patients with complete 12-month follow-up were analyzed. Mean peak flow rate increased from 9.32±3.18 to 15.6±4.49ml/s(40.3%,P=0.0001). Mean IPSS decreased from 21.63±6.28 to 11.85±6.05(45.5%,p=0.0001). Mean residual volume dropped from 64.93±64.31 to 24.10±19.86 ml (p=0.0001). In half of the patients, minor transient complications were encountered, including acute urinary retention after Foley removal in 10 patients (11.2%) hematuria in 18(20.2%), hematospermia in 15(11.2%), epididymitis in 13(14.6%), and decreased volume of ejaculate in 17(16.8%). Two major complications occurred. Urethrorectal fistula developed in a patient who had received TURP 8 years previous. The fistula healed after long-term catheterization for 4 months. Another patient complained of severe deep pelvic pain. MRI revealed inflammatory change and dilatation of the seminal vesicle. The pain was managed with analgesics. No further surgical procedure was required in either case. CONCLUSIONS: Our experience indicates that transrectal HIFU is safe, easy to implement, and effective in achieving satisfactory results.