The article below that recently (Endourol. 2010 Aug 30.) reports on a fairly high incidence of bladder outlet obstruction following HIFU utilizing the Ablatherm (EDAP) HIFU technology. This is another example of the difference between this HIFU technology and the Sonoblate-500 (Focus Surgery). Because Ablatherm HIFU lesion is limited to .25 cm in height and is not adjustable, versus the Sonoblate has multiple size transducers capable of creating the desired HIFU lesion height. HIFU treatment at the bladder neck and at the apex are very challenging when one is limited to a single large height HIFU lesion. The scatter of energy inadvertent propagated into the
In my experience, using the Sonoblate -500, I have not encountered very many cases that have resulted in having bladder neck contraction or obstruction. Which I feel is attributable to the option of smaller size transducers resulting in the desired size lesions. Thereby, decreasing the risk of the HIFU energy scatter into the surrounding tissue and creating scar formation. We also typically maintain a fairly full bladder during the actual hifu treatment with an effort to allow any scatter of energy result in a "heat sink effect" when the transference of energy to heat is dissipated into the filled bladder.
Endourol. 2010 Aug 30. [Epub ahead of print]
Development of Bladder Outlet Obstruction After a Single Treatment of Prostate Cancer with High-Intensity Focused Ultrasound: Experience with 226 Patients.
Netsch C, Pfeiffer D, Gross AJ.
Department of Urology, Asklepios Hospital Barmbek , Hamburg, Germany .
Abstract
Abstract Purpose: To investigate the occurrence of bladder outlet obstruction (BOO) after high-intensity focused ultrasound (HIFU) therapy of prostate cancer, the need for secondary transurethral interventions for BOO, and the benefit of transurethral resection of the prostate (TURP) before HIFU. Patients and Methods: After a single HIFU treatment between 2002 and 2007, 226 consecutive patients were examined and followed at least 2 years. The Ablatherm Maxis and the Integrated Imaging devices were used. The sites of BOO were recorded. Results: Median follow-up after HIFU was 52 months (range 24-80 mos). BOO developed in 58 (25.66%) patients. Repeated BOO episodes were observed in 27 (11.94%), three to seven episodes in 13 (5.75%) patients. Patients with repeated BOO were older than patients with singular BOO (71.75 +/- 4.97 vs 68.18 +/- 5.03; P = 0.024). In primary BOO, multiple sites of obstruction were more often involved than in repeated BOO (25/58 vs 8/27). Conversely, isolated bladder neck stenosis was predominantly found in patients with >/=two episodes of BOO. The rate of primary BOO was significantly different between patients who had undergone TURP the same day as HIFU or within 2 days of HIFU (33/96; 34.38%) and patients with TURP more than 1 month (16/89; 17.98%) before HIFU (P = 0.032). BOO occurred in 21.95% (9/41) of the patients who were treated with HIFU only. Conclusions: BOO after HIFU is common, particularly affecting the bladder neck. The risk of repeated BOO is associated with age. A longer interval between TURP and HIFU (>1 month) might reduce the risk for the development of BOO.
PMID: 20804429 [PubMed - as supplied by publisher]
George M. Suarez, M.D.
Medical Director,
The Miami Urology Center of Excellence
Cell: 305-310-8238
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