Post Operative Care

Sonablate 500 HIFU treated men typically spend about 2 hours in the recovery room after the procedure,instructed on care of the catheter and then return to their home. A normal diet may be resumed at this time. Men are encouraged to drink a liberal amount of fluids to encourage flow through the catheter and minimize its blockage possibly from a small clot.

Once any seepage about the entry wound of the suprapubic catheter settles the dressing here may be abandoned. After the first day the patient will have few limitations and may travel home. If he experience's some discomfort he may take the analgesic prescribed while scrotal swelling, if present,may be alleviated with an ice pack. A spontaneous bladder contraction in response to the HIFU treatment and or the catheter may generate a bladder spasm with some lower abdominal discomfort and the passage of a little urine and or blood from the penis and this is relatively common and should subside.

Also given are the following prescriptions:

• antibiotics for several days
• bladder antispasmodic such as vesicare to minimize bladder spasms.
• anti inflammatory such as mobic
• alpha blocker such as flomax to enhance urinary flow
• cialis to enhance erections

a) Immediate post operative concerns may be:
bleeding about the catheter
catheter blockage
bladder spasms
mild fever
bruising
discomfort in the lower abdomen/pelvic area
scrotal swelling

b) 1-2 weeks later after the catheter is removed and he begins to void he may experience:
leakage of urine from the entry puncture site where the supra pubic catheter entered the abdomen
difficulty voiding
bleeding during urination
elimination of prostatic necrotic debris
burning
urgency to urinate
incontinence,usually urge
frequency
urinary tract infection

c) later downsides may include
retrograde ejaculation
impotence
incontinence
urethral stricture

Follow Up

Initially in the first year particularly,the patient is seen every 3 months to monitor his PSA and also to ensure that his urination and his erections are normalizing.

a) monitoring of the PSA is important as it will suggest successful treatment or the possibility of residual or recurrent tumor. If the PSA is still of concern then the patient may need a rebiopsy of his prostate and/or additional imaging studies.
b) abnormal voiding habits may indicate the need for further studies such as a cystoscopy or possibly urodynamics to discover prostatic or urethral obstruction/impairment necessitating additional alternative treatments.

PSA nadir
The PSA nadir is the lowest PSA reading achieved after any treatment (surgery,radiation,cryoablation,Hifu) for prostate cancer and a PSA nadir of 0.2ng/ml is usually taken to indicate potential long term cure. The median PSA nadir three months after Hifu is usually less than o.2ng/ml.