Salvage robotic prostatectomy following whole gland high-intensity focused ultrasound with a Sonablate 500 device: technical feasibility and safety

High-intensity focused ultrasound (HIFU) has been used to treat localized prostate cancers. Similar to all forms of ablation, including radiation and cryoablation, there is a local persistence rate. Salvage robotic prostatectomy has been utilized but published series are multi-institutional, multi-surgeon, and do not segregate the different HIFU devices. The results are also grouped with other forms of ablation. This series describes the technical results of a single surgeon performing salvage robotic prostatectomy on only HIFU patients, and only after whole gland ablation on a Sonablate 500 device. A retrospective hospital and office chart review was performed of nine consecutive patients. Results of the surgical cases reveal an acceptable mean OR time of 130 min, mean estimated blood loss of 125 cc with no intraoperative or post-operative transfusions, and mean length of hospital stay of 2.4 days. Urinary catheters were removed after 7–10 days. All patients were pad free no longer than 35 days later. There was no surgical field or systemic complications in any patient. Intraoperative findings include diffuse fibrosis of the periprostatic tissues including the endopelvic and lateral pelvic fascia. The thermal changes make the surgery more tedious, particularly for nerve sparing. These cases support the stance that robotic salvage prostatectomy can be safely performed in this patient cohort with immediate surgical results similar to non-salvage cases.