HIFU

Possible complications and side effects

Discharge of necrotic tissue

In the first six weeks, pieces of tissue can be discharged during urination. The thermally damaged prostate tissue is sloughed off gradually. This can temporarily prejudice an initially good urinary flow. This complication is considerably reduced by a TURP procedure (removing slivers of the prostate) directly prior to HIFU. In rare cases it is necessary to remove necrotic tissue via the urethra if this is obstructing the urinary flow.

Administration of antibiotics for the duration of 2 weeks following treatment aims to avoid symptoms of infection such as urinary urgency and frequency as far as possible.

Incontinence

The ocurrence of a higher-grade incontinence after HIFU treatment is a minor problem. Approximately 91% - 95% of patients report no loss in continence. In the remaining cases the ability to hold urine can, as a rule, be remedied by pelvic floor exercise.

Impotence

In the case of treatment of the entire prostate, potency can be maintained in approximately 60% of all patients. Approximately 25% of patients report complete loss of potency. In the case of slight erectile disfunction, administration of drugs (so-called PDE5 inhibitors such as Viagra®, Levitra® and Cialis®), can bring about a marked improvement as regards potency.

Bladder outlet obstruction

Within months or even years following HIFU, shrinkage of the prostate can result in bladder neck stricture caused by scar tissue, whereby urination becomes impaired, sometimes very suddenly. In such cases, insertion of a catheter is necessary, followed by cutting a slit in the bladder sphincter via the urethra. In isolated cases, formation of a fibrous stricture can re-occur.

Recto-urethral fistula

The feared complication of a thermally-related connection between rectum and urethra (so-called recto-urethral fistula) is an extremely rare occurrence in connection with primary HIFU therapy in large series using the Ablatherm®-device of the latest generation. The frequency in large series reported in current literature ranges from 0 – 0.7%.