經尿道攝護腺刮除手術併高能聚焦式超音波取得較優良的短期功能性預後

林祖丞¹、林寬宇²、張睿哲¹、陳鈴雅³、黃亮鋼^1,4、甘弘成^1,4、邵翊紘^1,4、林柏宏^1,4、

吳俊德^1,4、馮思中^1,4、莊正鏗^1,4、虞凱傑^1,4*

林口長庚紀念醫院 外科部泌尿科；林口長庚紀念醫院 教學部；林口長庚紀念醫院 癌症中心；

長庚大學 醫學系

Transurethral Resection of Prostate with High-intensity Focused Ultrasound Achieves a Superior Short-Term Functional Outcome in Prostate Cancer Patients

Tsu-Chen Lin¹, Kuan-Yu Lin², Ruei-Je Chang¹, Ling-Ya Chen³, Liang-Kang Huang^1,4, Hung-Cheng Kan^1,4, I-Hung Shao^1,4, Po-Hung Lin^1,4, Chun-Te Wu^1,4, Cheng-Keng Chuang^1,4, See-Tong Pang^1,4,

Kai-Jie Yu^1,4*

1. Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan; 2. Department of Medical Education, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan; 3. Cancer Center, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan; 4.College of Medicine, Chang Gung University, Taoyuan City, Taiwan

Purpose:

High-intensity focused ultrasound (HIFU) has been considered as a treatment option of carefully selected patients with localized prostate cancer. Urinary incontinence, erectile dysfunction, rectourethral fistula, acute urinary retention and urinary tract infection, have been shown be post-operative complication of HIFU. Acute urinary retention has been reported to occur in as high as 28.3% of the cohort receiving HIFU. Thus, we aimed to investigate the efficacy and safety of concurrent transurethral resection of prostate (TURP) with HIFU in patients with prostate cancer.

Materials and Methods:

A retrospective analysis was conducted in a tertiary medical center from January 1, 2021 to October 15, 2023. Patients with localized prostate cancer who received HIFU treatment were included in the analysis. The cohort was stratified into two groups: group A (HIFU only), group B (HIFU with TURP). Short term oncological and functional outcomes and complication analyses were analyzed. Complication analysis of peri-operative complication and post-operative complication were performed. This study was approved by the ethical committee of the institution.

Results:

52 prostate cancer patients who received HIFU were included in the analysis. Group A is comprised of 26 patients who received only HIFU, and group B included 26 patients who received concurrent TURP with HIFU. Baseline characteristics, including prostate volume and PSA level, among the two groups were similar except for an older population in group B. Both groups exhibit similar PSA level during follow-up. In the post-operative complication analyses, no significant difference was seen in post-operative stay, emergency room visit, readmission, reoperation. However, a significantly longer operative time was seen in the group B cohort. Meanwhile, group B patients experience a significantly lower rate of acute urinary retention. 

Conclusion:

Concurrent TURP with HIFU achieves a superior functional short-term outcome with a significantly lower rate of acute urinary retention and a similar safety and oncological analysis.