The Treatment Procedure

Pre-operative preparation.

Routine investigations to ensure localised disease should be undertaken and the prostate volume and dimensions should be assessed.

The ideal prostate should be less than 40cc in volume with an A/P length of less than 24mm.

Large prostates may require a period of cytoreduction with hormone manipulation prior to the treatment which can be stopped immediately post-operatively.

Smaller prostates can have a limited on table TURP / laser prostatectomy at the time of HIFU to reduce the volume and post-operative catheterisation time. Because of the thermal injury caused by the HIFU the prostatic bleeding is very minimal.

The patient is prepared on the morning of surgery with an enema to ensure an empty rectum.

 

The Operation

The patient is catheterised and placed in the right lateral position on the specifically designed bed.

The endorectal probe is placed inside a latex sheath which is filled with the coupling and rectal cooling gel for the single use Ablapak ™ (supplied).

Preset software packages for primary treatment, salvage treatment after radiotherapy or repeat HIFU treatment allow ideal power delivery to the prostate.

The real time imaging allows exact mapping of the prostate throughout treatment.

A patient movement sensor, automatic rectal wall distance calculation, automated probe movement with relation to rectal wall and rectal cooling ensure no accidental rectal damage.

The treatment time depends on the prostatic size, a 35cc prostate will require 400-600 shot and take 2 – 2 1/2 hours.

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 shaped like a grain of rice and measures 19 to 24 mm in height by 2 mm in diameter. By repeating the shots, and moving the focal point between each shot, it is possible to destroy a volume that includes the whole prostate.