Long-term outcome of transrectal high-intensity focused ultrasound therapyfor benign prostatic hyperplasia

Objective: The aim of this study was to determine the long-term outcome aft er transrectal high-intensity focused ultrasound (HIFU) therapy for patient s with lower urinary tract symptoms (LUTS) due to benign prostatic hyperpla sia (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. Principa l inclusion criteria were a peak flow rate (Qmax) less than or equal to 15 ml/s, AUA/IPSS score greater than or equal to 18 and a prostate volume less than or equal to 75 ml. Postoperatively, patients were seen at 6-month int ervals with assessment of symptom score, uroflowmetry and post-void residua l volume. In the present analysis, follow-up was terminated at 4 years. The mean follow-up of the study population (excluding the patients who underwe nt transurethral resection of the prostate, TURF, due to insufficient thera peutic response) was 41.3 months (range: 13-48 months). Results: In treatment responders (HIFU only; n = 45), the symptom score dec reased from preoperatively 19.6 to 8.5 (-53%) after 12 months and subsequen tly showed only marginal fluctuations within the 4-year study period. The Q max 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%) un derwent TURF due to insufficient therapeutic response during the 4-year stu dy period. The mean time interval between HIFU therapy and TURF was 26.5+/- 2.7 months (range: 1-48 months). The retreatment-free period was significan tly longer for patients with a pretreatment average flow rate >5 ml/s (p = 0.05) and lower grades of urodynamically documented bladder outflow obstruc tion (p = 0.03). A similar trend, which did not reach statistical significa nce, was noted for individuals with higher Qmax and lower post-void residua ls. Conclusions: These long-time data indicate that transrectal HIFU therapy fo r BPH, at least in its present form, did not sta nd the test of ti me, as 4 3.8% of patients had to undergo TURP with in 4 years after initial therapy. These data underline the need for long-term studies with follow-ups over s everal years to reliably assess the role of less invasive treatment options for BPH. Copyright (C) 2000 S. Karger AG, Basel.