I had a Sonablate HIFU treatment on March 29th, 2008. I am in the process of recovery now. I was originally going to have the Albatherm in Toronto, Ont. Canada. It would cost $21,930 and that included them putting you up in a hotel for two nights. What happen is that my prostate had to be shrunk to 40cc or less from 72cc. After 4.5 months on Androgen deprivation therapy it only reach 43.5cc too large for their probe. They were getting a new probe that could do larger prostates but mine was at the limit of the probe so I did not want to risk having to do it again. The Toronto Albatherm clinic has good stats with only having to repeat two treatments in over 300. So I decided to go with the Sonablate which can do prostates as large as 50cc as a new clinic open in Winnipeg only a few hours drive for home, so no plane flight. The Sonablate cost was $22,000 and I had to pay for the hotel costs.
Complications
I had my suprapubic catheter (a catheter put through the abdomen wall above the pubic bone into the bladder) plug three times which require my having to go to the emergency to get it flushed and in third time a urethral catheter was inserted (through the penis). I did have problem with bladder spasms and pain during urination. These were all controlled with an anti spasmodic drug, Detrol LA, and anti inflammatory drug to reduce the prostate size. Apparently my large prostate with the subsequent swelling from the procedure--inflammation, cause the pain during urination. I have had no continent issues right from the beginning. The only thing which is common with HIFU is that you have a strong urgency to urinate and that is right now so you need to know where a bathroom is all the time. You will also need to go frequently as you are drinking a lot of water. These two things subside over two to four weeks. I am five weeks out of the operation and I have no catheter and only have some frequency to urinate during the night but that to will subside. The frequency is decreasing.
Experience
The Sonablate doctors have to go through a course and it seems that they work with another Sonablate doctor for experience, but the more experience they have the better. Don't know about the Albatherm but I suspect it is similar.
Differences and similarities
Both machines include a motion detector and a rectal temperature monitor. Because the machine is taking such as small strip of tissue and heating it to 80 to 90 degrees Celius you cannot have any movement as that would cause the machine to hit the wrong target. The motion detector causes the machine to shut off thus protecting the wrong tissue from being destroyed.
Both machines have the probe covered by a condom that has degassed water pumped in to swell the condom to make a tight fit to the rectal wall. The water is cooled to keep the transducer and rectal wall cool. This avoids any heat damage that may occur to the rectal wall.
The Sonoblate machine has its transducer ( the sound emitting device) in a cylinder attached to the end of the probe. The transducer consists of two transducers one for deeper treatment and one for shallower treatment. The transducer moves within a cylinder at the end of the probe so the probe does not move once it is positioned. Both probes can be used to for treatment or imaging. The Sonablate machine takes images after each treatment shot so the doctor has a continuous upto date image of the prostate and any changes that occur during treatment. The prostate will swell with the first shot to increase in size about 10% at least that is what happened with my prostate. As pointed out the Sonablate has a doppler imaging system to give good color and identification of the nerve and vascular (blood vessel) bundles.
The Albatherm has one transducer at the end of the probe and it is fixed. The whole probe moves back and forth in the rectum during the treatment phase. The Albatherm can take only one picture at the beginning of the procedure as it requires a different transducer to take the image. That transduce must slide out into position while to treatment transducer is retracted. The imaging system can identify the nerve and vascular bundles.
The Sonablate procedure has the man lying on his back with his legs up in stirups. You are under a spinal but can also be under a sedation to make you sleep. However, in the Sonablate procedure a patient can in fact not take the sedation and so be awake through the whole process. I was awake during my procedure.
The Albatherm procedure has the man lying on his right side on the Albatherm table and he has both the spinal and the sedation for the procedure. No option to be awake.
Both have good result with incontinuence and erectile dysfunction. The Sonablate procedure has stats of 0.6% incontinuence. The Albatherm stats shows a 5 to 6% with most of that type I or II incontinuence which means the man will get a drop or two when he exerts himself in activities like lift a weight or swinging a golf club. Their stats show that a very small number may show a more serious type of incontinuence but this is very rare. Remember that Albatherm has better stats data that Sonablate as the Albatherm has been monitoring for a long time and Sonablate systems have not. Erectile dysfunction is stated at 20% but I think this is too high as the updated technology has improved the systems and the use of Cialis after the catheter is out will help regain the erectile function. I know that Sonablate treatment includes Cialis but the Albatherm as far as I have seen does not.
The Albatherm frequently will have the patient undergo a TURP (transurethral resection of the Prostate) in order to reduce the size of the prostate and apparently this also eliminates the pain after the treatment. The Sonablate system does not use the TURP. The TURP can cause its own problems and there is a risk of damaging the sphincters that control urine flow even though this maybe a low risk
The Sonablate machine takes a treatment strip that is 1 to 2 mm by 10 to 15 mm long while the Albatherm machine takes a strip that is 1 to 2 mm by 18 to 24mm long. The Sonablate system divides the prostate into 3 zones with each zone consisting of two blocks. The Albatherm does not appear to have zones but only blocks across the entire prostate. The Sonablate with its smaller strip length can get into tighter corners of the prostate.