Category: New Technology: Miscellaneous
Introduction & Objective : Erectile Dysfunction and Urinary Incontinence are common in many elderly men.
Likewise, Prostate Cancer is equally common in the same age population. Herein we introduce our experience with performing HIFU in 21 men who had either/and/or a penile prosthesis and/or artificial urinary sphincter.
The treatment options for a man with a genital urologic prosthesis presents a challenge for the treating urologist. Malfunction of the implanted device, particularly the risk of infection to the implanted prosthesis is a major concern.
Methods : A total of 21 men with either/and/or a penile implant and/or an artificial sphincter were diagnosed with biopsy proven prostate cancer. The cohort of patients had a common denominator which was a penile implant, of which 17 men had a previous history of radiation therapy and a transurethral resection of the prostate (TURP). 4 men had sexual/erectile dysfunction. 12 of the 17 men with radiation therapy suffered from both erectile dysfunction and urinary incontinence, the other 4 were previously treated by transurethral resection and were rendered incontinent.
Results : All 21 patients had a biopsy proven adeno carcinoma of the prostate and were subjected to HIFU, as the most non invasive medical therapy for prostate cancer. Patients were followed for 15 to 1 year. Function of the genital implants remained unchanged with satisfactory baseline function in the period following the procedure.
Additionally a total of 10 inflatable penile implants, 10 maliable implants and 10 artificial sphincters had HIFU applied within a water bath (identical to the calibration of the pre HIFU patient). In all prosthetic devices, (Inflatable Maleable Implants and AUS), there appeared to be no compromise of the structure and/or integrity of the implanted urologic prosthesis. This was confirmed by visual and functional observation, as well as electron microscopy at 360 degrees of magnification.
Conclusions : HIFU is a unique and newly approved FDA therapy, since 2015 for localized prostate cancer. The patient with a urogenital prosthetic device and a diagnose biopsy proven prostate cancer is a challenge. Herein we present a non-invasive viable alternative, HIFU, for such patients. In all 21 patients we had no complications or secondary side effects and we are pleased to report a positive clinical outcome with a PSA less than 0.5 or less.