Early Effects of High-Intensity Focused Ultrasound (HIFU) Treatment for Prostate Cancer on Fecal Continence and Anorectal Physiology

Abstract OBJECTIVE : To evaluate high-intensity focal ultrasound (HIFU) effects on anorectal physiology and fecal continence or constipation, and on quality of life (QoL). METHODOLOGY : We prospectively evaluated 26 patients with localized prostate cancer who underwent HIFU. The Rome III criteria for functional constipation, the Cleveland Clinic Florida Fecal Incontinence Score(CCFFIS), and the Fecal Incontinence Quality of Life Score(FIQL) questionnaires were answered before and after treatment. Anorectal manometry was used to evaluate resting and squeezing pressures, sustained contraction, paradoxical puborectalis contraction, rectal sensation, and rectal capacity. RESULTS : Thirteen patients underwent hemiablation and 13 underwent whole-gland ablation. There was no difference between groups regarding the Rome III criteria for functional constipation results. The CCFFIS results showed that 3 (11.5%) of patients had mild fecal incontinence before HIFU and 5 (19.2%) had it afterward(p=0.625). No patients reported poor QoL due to fecal incontinence in the FIQL. Anorectal manometry demonstrated no decrease in resting pressure after treatment(p=0.299), while squeezing pressure significantly increased from 151.87 to 167.91mmHg(p=0.034). The number of patients with normal sustained contraction remained the same [20 (77%)]. Paradoxical puborectalis contraction was seen in 12 (46%) of the patients before the procedure and in 13 (50%) after (p=0.713). Improvement in sensory parameters was not significant: first sense changed from 73.46 to 49.71mL (p=0.542) and first urge from 98.27 to 82.88 mL(p=0.106). Rectal capacity had a nonsignificant decrease from 166.15 to 141.15mL (p=0.073). CONCLUSIONS : HIFU did not cause significant changes in anorectal physiology. Fecal incontinence or constipation after HIFU was not observed via validated questionnaires.