Preparation

The patient is hospitalized the evening before the treatment, the patient is given an enema for colorectal preparation approximately two hours before treatment.

Procedure The treatment is generally performed under spinal anesthesia. The treatment is executed with the patient lying in a right lateral position. Strict immobility is necessary during the treatment, which explains the administration of a sedative.

The treatment is performed transrectally, generally under spinal anesthesia. A probe is placed in the rectum. This probe emits a beam of high intensity convergent ultrasound. In the point where the ultrasounds are focused (focal point) the sudden and intense absorption of the ultrasound beam creates a sudden elevation of the temperature (from 85 to 100°C) which destroys the cells located in the targeted zone.

The targeted prostatic volume is localized with the biplan ultrasound imaging probe.		High-energy ultrasound waves are focused through the rectal wall to the targeted prostate area.

The targeted zone destroyed by each shot is oval-shaped and measures up to 24 mm in height by less than 2 mm in diameter. Repeating the shots, and moving the focal point between each shot, it is possible to destroy a volume that includes the whole tumor (400 to 600 shots are generally done to treat the volume previously defined).

The treatment duration varies according to prostate volume (1 to 2 hours). Swelling of the prostate appears immediately after the treatment and compresses the urethra. A temporary urine catheter is inserted. This allows the elimination of urine until the edema recedes (which takes generally from 3 to 8 days depending on the case).
To reduce the need for post treatment catheterization, a “mini” transurethral resection can be done before or immediately after the treatment with HIFU (during the same anesthesia): this is mainly performed on patients presenting with signs of prostatic obstruction (weak urinary stream, frequent nocturnal urination, residual urine volume in the bladder).

(*) Approved in the European Union (CE marked), under investigation in the US.