Effect of subtotal transurethral resection of prostate performed prior to high-intensity focused ultrasound on risk of urological complications in patients with localized prostate cancer

Aim. To assess the rate and reasons for urological complications of subtotal transurethral resection of prostate performed prior to high-intensity focused ultrasound. Methods. The study included 101 patients with localized prostate cancer treated by high-intensity focused ultrasound. Two groups of patients were allocated. Patients, who did not undergo transurethral resection of prostate prior to high-intensity focused ultrasound, were included in group 1 (21 patients). Second group included patients in whom subtotal transurethral resection of prostate was performed prior to high-intensity focused ultrasound to decrease anteroposterior diameter of the prostate and urethral canal compression. The impact of treatment tactics on complications rate was defined by factor analysis. Results. Early post-surgical complications were rare, complications mostly occurred at late period. The most frequent, severe and poorly controlled complications included urinary incontinence [58 (57.8%) patients] and urethral stricture [30 (29.7%) patients]. Most of complications were registered in second group of patients compared to the first: first group - in 10 (12.5%) of cases, second group - in 77 (95.0%) of cases. Urinary incontinence was observed in 7 (33.3%) patients and urethral stricture - in 4 (19%) of patients in the first group; in 51 (63.7%) and 26 (32.5%) patients in the second group respectively; the difference was statistically significant. Conclusion. Comparative analysis of different approaches to treatment of localized prostate cancer using high-intensity focused ultrasound revealed that subtotal transurethral resection of prostate performed prior to high-intensity focused ultrasound significantly increases the risk for developing urinary incontinence and urethral strictures.