Transurethral resection of the prostate immediately after high-intensity focused ultrasound treatment for prostate cancer

Objectives: To evaluate the long-term outcomes of transurethral resection of the prostate (TURP) immediately after high-intensity focused ultrasound (HIFU) treatment for prostate cancer (CaP). Methods: The present retrospective study included 65 CaP patients who underwent HIFU alone and 64 patients who underwent TURP immediately after HIFU. HIFU treatment was carried out using a Sonablate-500 HIFU device (Focus Surgery, Indianapolis, IN, USA). International Prostate Symptom Score (IPSS) and the occurrence of urinary complications, such as urethral stricture during follow-up, were statistically compared between groups. Results: Clinical stage tended to be lower for the HIFU + TURP group (P = 0.0311), but none of the preoperative parameters differed significantly between groups. Both catheterization time (P < 0.0001) and post-treatment IPSS (P < 0.0001) at 6, 12, and 24 months after treatment differed significantly between groups. Urethral strictures were noted in 16 (24.6%) of the HIFU-only patients and seven (10.9%) of the HIFU + TURP patients. Bladder neck contracture was noted in 11 (68.8%) of the patients with urethral stricture in the HIFU-only group, but in just two (28.6%) of the patients with urethral stricture in the HIFU + TURP group. Multiple logistic regression analyses showed that TURP resection volume (P = 0.0118) was a strong factor for the prevention of urethral stricture. Conclusions: Our results suggest that combining HIFU with an immediately following TURP improves post-treatment urinary status without causing additional morbidity.