A NOVEL TECHNOLOGY FOR PROSTATE ENLARGEMENT (BPH) TREATMENT – PROSTATE HIFU

Focused ultrasound is an early-stage, noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with BPH. This novel technology focuses beams of ultrasound energy precisely and accurately on targets in the body without damaging surrounding normal tissue.

How it Works
Where the beams converge, focused ultrasound produces precise ablation (thermal destruction of tissue) enabling BPH to be treated without surgery.

Advantages
The primary options for treatment of BPH include medication and invasive surgery. 

For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with less risk of complications – such as surgical wound healing or infection – at a lower cost. It can reach the desired target without damaging surrounding tissue and is repeatable, if necessary. One of the main advantage is there is no retrograde ejaculation.

What is HIFU treatment?

High-intensity focused ultrasound (HIFU) uses high intensity ultrasound energy to destroy the tissue in prostate. A beam of ultrasound energy reaches prostate via a probe placed in anus (rectum).

High-intensity sound waves form heat by focusing on a specific point. Given on a specific location in the body, HIFU energy reaches up to approximately 195 degrees Fahrenheit in just a few seconds on the focal point. Thus the tissue is destroyed without any surgical operation in the body, while the tissue besides the focal point remains unharmed. By this means intended treatment is given without harming the healthy prostate tissues surrounding the focal point.

This minimally invasive procedure is provided as an outpatient treatment.

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What will happen during your treatment?

You will be sedated by general anesthesia during the treatment. If for some health reasons, you are not fit for general anesthesia, you may have spinal (epidural) anesthesia which will ensure that you will not to feel anything in your lower body.

During treatment you will lie on your back with your legs open or on your side with your knees drawn up to your chest. Your doctor or nurse will tell you which position you should take while lying down.

In order to empty your bladder, a catheter may be used in the beginning of the treatment. Catheter is a tiny tube that is inserted into your bladder through the penis.

Surgeon will insert a probe inside your rectum. The probe will give high-intensity ultrasonic energy beam to the prostate. Every time the beam is emitted, it will cure a small area of the prostate (10x3mm area cube). Surgeon will move the beam in such a manner to heat up and destroy the cancer cells.

On Whom HIFU can be used?

HIFU treatment is advised,

On patients who don’t want to experience post-surgery problems of erection and urinary incontinence,

On patients who are not fit for surgery (elderly patient, general health disorder, etc.),

On patients who don’t want to go through surgery,

On patients who have previously had abdominal surgery.

How many kinds of HIFU exist and what are these?

There are two kinds of HIFU treatment

1. Whole prostate gland HIFU; cures the entire prostate and it takes about three hours. It may be suitable for men who needs to be treated in more than one part of prostate.

2. Focal point HIFU treats some part of prostate and it takes about 1 to 2 hours. It may not be appropriate for BPH treatment. This type of HIFU is suitable for men who have prostate cancer that needs to be treated on only one part.

What are other minimally invasive treatment methods for prostate cancer besides HIFU?

There are several types of minimally invasive or surgical therapies.

Transurethral resection of the prostate (TURP)

A lighted scope is inserted into your urethra, and the surgeon removes all but the outer part of the prostate. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP you might temporarily need a catheter to drain your bladder.

Transurethral incision of the prostate (TUIP)

A lighted scope is inserted into your urethra, and the surgeon makes one or two small cuts in the prostate gland — making it easier for urine to pass through the urethra. This surgery might be an option if you have a small or moderately enlarged prostate gland, especially if you have health problems that make other surgeries too risky.

Transurethral microwave thermotherapy (TUMT)

Your doctor inserts a special electrode through your urethra into your prostate area. Microwave energy from the electrode destroys the inner portion of the enlarged prostate gland, shrinking it and easing urine flow. TUMT might only partially relieve your symptoms, and it might take some time before you notice results. This surgery is generally used only on small prostates in special circumstances because re-treatment might be necessary.

Transurethral needle ablation (TUNA)

In this procedure, a scope is passed into your urethra, allowing your doctor to place needles into your prostate gland. Radio waves pass through the needles, heating and destroying excess prostate tissue that’s blocking urine flow. TUNA may be an option in select cases, but the procedure is rarely used any longer.

Laser therapy

A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy generally relieves symptoms right away and has a lower risk of side effects than does nonlaser surgery. Laser therapy might be used in men who shouldn’t have other prostate procedures because they take blood-thinning medications.

The options for laser therapy include:

• Ablative procedures. These procedures vaporize obstructive prostate tissue to increase urine flow. Examples include photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate (HoLAP). Ablative procedures can cause irritating urinary symptoms after surgery, so in rare situations another resection procedure might be needed at some point.
• Enucleative procedures. Enucleative procedures, such as holmium laser enucleation of the prostate (HoLEP), generally remove all the prostate tissue blocking urine flow and prevent regrowth of tissue. The removed tissue can be examined for prostate cancer and other conditions. These procedures are similar to open prostatectomy.

 

Prostatic urethral lift (PUL)

Special tags are used to compress the sides of the prostate to increase the flow of urine. The procedure might be recommended if you have lower urinary tract symptoms. PUL also might be offered to some men concerned about treatment impact on erectile dysfunction and ejaculatory problems, since the effect on ejaculation and sexual function is much lower with PUL that it is with TURP.

Embolization

In this experimental procedure, the blood supply to or from the prostate is selectively blocked, causing the prostate to decrease in size. Long-term data on the effectiveness of this procedure aren’t available.

Open or robot-assisted prostatectomy

The surgeon makes an incision in your lower abdomen to reach the prostate and remove tissue. Open prostatectomy is generally done if you have a very large prostate, bladder damage or other complicating factors. The surgery usually requires a short hospital stay and is associated with a higher risk of needing a blood transfusion. Yet there are many side effects of surgical treatment methods. Primary side effects of surgery is urinary incontinence and erection disorder.

COMPARISION OF NOVEL MINIMALY INVASIVE TECHNIQUES

What are the advantages of HIFU compared to other traditional or novel BPH treatment methods?

• Risk of complication is low. It gives the opportunity to BPH treatment without harming the surrounding organ and tissues.
• It provides an important advantage in preserving sexual life and bladder control.
• There is no blood loss and pain.
• There is rapid recovery. Patients are discharged the same day or one day after at most.
• It is a nonsurgical procedure. It is a good option for those patients who don’t want to go through surgery or other minimally invasive techniques (elderly patients)
• There is no incision.
• It is a one-session procedure.
• Outpatient procedure is conducted. 

 

BENEFITS TO THE PATIENT

• Reduced risk of incontinence
• Reduced risk of erectile dysfunction
• Preservation of ejaculation (No retrograde ejaculation!!!)
• Maintenance of prostate tissue
• Minimal invasive procedure
• Shorter period of procedure
• Outpatient treatment
• Rapid recovery
• Goes back to work in a few days.

 

What kind of preparation is necessary prior to HIFU treatment procedure?

Patient should use antibiotics one day before the procedure and should not eat or during 6 hours prior to the procedure. You will be given enema to empty your bowels in the morning of your HIFU treatment.

How much time does the treatment take?

It lasts for approximately 1,5 – 2 hours yet the procedure time may vary according to the size of the prostate.

Is HIFU treatment painful?

The treatment itself is not painful since it is carried out under general anesthesia. Rarely there might be post-treatment pain, most patients feel a slight disturbance which heals after a few days. Since the procedure is not interventional there are no incisions or scars.

How much time does it to return to normal life after HIFU treatment?

Our patients are discharged on the day of procedure of after 1 day. Our patients can generally stand up and walk a few hours after the procedure.

What are the side effects of HIFU?

There are far less side effects after HIFU treatment compared to other invasive procedures (surgery, brachytherapy etc.). Side effect rates are much less done by the hands of experienced surgeons.

Though rarely, side effects such as urinary problems, erection and maintenance of erection (erectile dysfunction) are noted in literature.

1. Blood and tissue in urine: While catheter is in place, you might see some blood in your urine. 6 to 8 weeks after HIFU procedure, you may see some small prostate tissue in your urine. This is normal. Yet if you get anxious, please consult your doctor.
2. Erection problems: Very seldom erection and maintaining erection  (erectile dysfunction) problems might be observed in some patients after HIFU procedure. The reason for this is that the procedure might harm some blood vessels and nerves that control erection. For some men this is a temporary problem. Yet sometimes the side effect might be a longer-term problem.
3. Urinary infections: Some men have urinary infections after HIFU procedure. The symptoms of a possible urinary infection are:

• fever (high temperature)
• burning feeling when urinating
• dark or blurred urine with a strong odor
• need to urinate more frequently than usual

         If you have any symptoms of a urinary infections, please consult your doctor. He will generally treat you with antibiotics.

After your treatment

You may go home on the same day of procedure or the next day. Very seldom patients might feel pain, yet you will be given pain relievers that you can take at home.

You will also take antibiotics to prevent any possible infection and you might also be given laxatives to help you empty your bowels.

HIFU procedure generally causes prostate to swell and this might make urinating hard. A catheter will be inserted to help you empty the urine in your bladder until swelling is over.

Your doctor or nurse will show how to use your catheter before you go home.

How is follow-up after the treatment?

Catheter is taken out 7 days after the procedure.