Transrectal high-intensity focused ultrasound (HIFU) treatment of localized prostate cancer: review of technical incidents and morbidity after 5 years of use.
The objective of this study was to report on technical incidents and early and late complications occurring in high-intensity focused ultrasound (HIFU) treatment of patients with localized prostate cancer. We performed a retrospective review of patients who were treated by Ablatherm at our centre. We recorded all technical incidents, treatment discontinuations and early (<1 month) and late complications. A total of 74 HIFU procedures were performed in 65 patients (55 first-line HIFU treatments and 10 cases of salvage therapy after radiotherapy) over a 5-year period. Median follow-up was 41 months (10-64 months). All the procedures were well tolerated and no intra- or peri-operative deaths occurred. Six technical incidents in the overall population (8.1%) led to discontinuation of the procedure. The early complication rate in patients undergoing first-line HIFU was 36.4%: urinary retention (20%), dysuria (5.4%), urinary infection (3.6%), haematuria (3.6%) and urethral stenosis (3.6%). The late complication rate was 12.7%: urethral stenosis (9%) and dysuria (3.6%). There were no cases of rectourethral fistula. The long-term urinary incontinence rate was 20% and the de novo erectile dysfunction rate was 77.1%. Nine complications (16.4%) required surgical management. The overall complication rate was 49%. Ablatherm is a reliable technique with a relatively high complication rate. However, most complications were minor and required surgical management in a few cases only. Our results confirm that all patients who are offered HIFU treatment should be properly informed of the risks, in particular with regard to continence and sexual function.
Ripert
T
T
Department of Urology and Andrology, CHU Reims, Reims, France. thomas_ripert@yahoo.fr
Azémar
M-D
MD
Ménard
J
J
Bayoud
Y
Y
Messaoudi
R
R
Duval
F
F
Staerman
F
F
D000368:Aged; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D008297:Male; D011467:Prostate / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects; D020728:Transurethral Resection of Prostate; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects*; D014525:Urethral Stricture / Q000209:etiology; D014549:Urinary Incontinence / Q000209:etiology