Preparation for HIFU
The rectal cavity needs to be cleaned prior to the HIFU procedure. For this, it is recommended that the patient take 1-2 FLEETS of Enema at least 2 hours prior to the procedure or the night before procedure. If the patient is experiencing constipation, he might also take a bottle of magnesium citrate, which is a prescription obtained from the doctor. Patient is also advised to take prophylactic antibiotics at least 3 days prior to procedure.
Is the procedure done with an anesthetic?
Anesthesia is required to prevent patient movement. Your anesthesiologist will decide the type of anesthesia. Since there is no cutting of body tissue and no loss of body fluids, minimal anesthesia is required. The procedure begins by a catheter being placed into the penis once the patient is anesthetized and asleep. Some doctors may put a Supra-pubic catheter. You can discuss this with your doctor prior to procedure.
Planning and Treatment
The procedure is planned by measuring prostate in 3 dimensions and deciding the amount of lesions that needs to be placed to obtain full treatment. Once this is done, treatment will start in zones. Each lesion is the size of a rice grain and each zone will consist of several lesions. The lesions are cigar shaped. Treatment will continue until all planned zones are ablated. The time of treatment varies between 1-4 hours depending on whether half a gland is being treated or the whole gland is being treated.
What happens during HIFU?
During HIFU, the physician not only treats the various zones as planned, but also looks at tissue change monitoring to make sure that the color change in the tissue happens to document good treatment. If there is no color change, a second pass may be required. For those patients who are under going nerve sparing, the US allows monitoring of blood flow and maintenance of this blood flow will assure maintenance of sexual function. This can only be done on the side of the prostate where there is no cancer close to it.
What happens after HIFU?
After HIFU procedure, you will be placed in a recovery room for about an hour when you wake up. After that, you will have a catheter for a few days and go home the same day. You will be able to do most of the normal activities in 1-2 days. You will be given antibiotics and medications to prevent bladder spasms. Flomax or similar drug will also be given for a few days before having your catheter removed to assist with voiding. After the catheter is removed, you may experience some urinary frequency and other symptoms. You will be able to call our nurse at the call center who has experience in dealing with all these problems. We would also train nurses at your local urology office to care for you in case you need to go back for medications or other care.
It is important that after you have HIFU that you don’t get additional surgery such as the TURP without consulting us. The proper management is to get a laser or TURP before the HIFU treatment if you have urinary symptoms. If you develop urinary symptoms after HIFU treatment, it is better to treat it with a catheter and let the healing process go for a longer period rather than rushing to any additional surgery as this may cause more incontinence. HIFU Solution will continue to help patients after the procedure by providing long-term follow-up.
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Will I require other medications after treatment?
Yes. You will need to be on an antibiotic while you have a catheter due to the fact that there is a small risk that it can cause a urinary tract infection. You will also be given a prescription to reduce spasms, which can occur for a brief time after treatment. To alleviate pelvic cramping, sitting in a tub of warm water is helpful. You will also be given Flomax or a similar drug a few days before having your catheter removed to assist with voiding. Most patients usually do not need pain medications after this treatment.