Long–Term Outcome of Transrectal High– Intensity Focused Ultrasound Therapy for Benign Prostatic Hyperplasia

Abstract

Objective: The aim of this study was to determine the long–term outcome after transrectal high–intensity focused ultrasound (HIFU) therapy for patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).Methods: Between June 1992 and March 1995, 98 men (mean age: 66 years) with LUTS due to BPH underwent transrectal HIFU therapy at our institution, and the data of 80 patients were included in this long–term analysis. Principal inclusion criteria were a peak flow rate (Qmax) ≤15 ml/s, AUA/IPSS score ≥18 and a prostate volume ≤75 ml. Postoperatively, patients were seen at 6–month intervals with assessment of symptom score, uroflowmetry and post–void residual volume. In the present analysis, follow–up was terminated at 4 years. The mean follow–up of the study population (excluding the patients who underwent transurethral resection of the prostate, TURP, due to insufficient therapeutic response) was 41.3 months (range: 13–48 months).Results: In treatment responders (HIFU only; n = 45), the symptom score decreased from preoperatively 19.6 to 8.5 (–53%) after 12 months and subsequently showed only marginal fluctuations within the 4–year study period. The Qmax increased from preoperatively 9.1 to 11.8 ml/s (+30%) after 12 months and gradually declined to 10.2 ml/s (+12%) after 4 years. 35 men (43.8%) underwent TURP due to insufficient therapeutic response during the 4–year study period. The mean time interval between HIFU therapy and TURP was 26.5±2.7 months (range: 1–48 months). The retreatment–free period was significantly longer for patients with a pretreatment average flow rate >5 ml/s (p = 0.05) and lower grades of urodynamically documented bladder outflow obstruction (p = 0.03). A similar trend, which did not reach statistical significance, was noted for individuals with higher Qmax and lower post–void residuals.Conclusions: These long–time data indicate that transrectal HIFU therapy for BPH, at least in its present form, did not stand the test of time, as 43.8% of patients had to undergo TURP within 4 years after initial therapy. These data underline the need for long–term studies with follow–ups over several years to reliably assess the role of less invasive treatment options for BPH.