Häcker A, Köhrmann KU, Back W, Kraut O, Marlinghaus E, Alken P, Michel MS. Extracorporeal application of high-intensity focused ultrasound for prostatic tissue ablation.
BJU Int 2005;
96:71-6. [PMID:
15963124 DOI:
10.1111/j.1464-410x.2005.05570.x]
[Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE
To investigate the efficacy and safety of extracorporeal prostatic tissue ablation using high-intensity focused ultrasound (HIFU) in vivo in animals, and in a clinical feasibility study in men, as this is an investigational minimally invasive treatment alternative for locally confined prostatic carcinoma, but may have significant side-effects.
PATIENTS, MATERIALS AND METHODS
Ultrasound (1.04 MHz excitation frequency) was generated by an extracorporeal cylindrical piezo-ceramic element and focused by a paraboloidal reflector to a focal size of 32 x 4 mm. The focal distance and aperture diameter were both 100 mm. HIFU was applied extracorporeally at different intensities and pulse duration (up to 6 s) to 11 dog prostates in vivo (median intensity 1192 W/cm2) and eight patients (median intensity 3278 W/cm2, range 2384-3576) under general anaesthesia. The lesions were assessed macroscopically and histologically after HIFU and any side-effects evaluated.
RESULTS
Thermoablation was feasible in vivo and in all patients. Macroscopic analysis and histology showed sharply demarcated coagulative necrosis. Side-effects, including skin and rectal burns, occurred only after transvesical application in the in vivo study. There were no side-effects in patients after perineal application.
CONCLUSION
Extracorporeal HIFU is technically feasible and induces sharply demarcated tissue damage in the prostate. From the early results of this phase 1 study, the perineal approach seems to be safe.
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