Removal of Prostate Calcifications Prior to TULSA-PRO With the Aid of Real-Time Ultrasound Imaging: Our Technique and Experience

Prostate calcifications can impede ultrasound energy propagation during transurethral ultrasound ablation (TULSA-PRO, Profound Medical Inc., Mississauga, ON, Canada). We instituted a pre-procedure screening protocol using low-dose pelvic computed tomography (CT) with ≤2-mm slices to detect calcifications larger than 3 mm along the planned ablation path; when obstructing deposits are present, we clear them immediately before treatment. Drawing on image-guided principles used in Aquablation (AquaBeam Robotic System, PROCEPT BioRobotics, San Jose, CA, USA), we correlate preoperative sagittal CT with real-time, stepper-mounted transrectal ultrasound (TRUS) to localize targeted prostate tissue for limited bipolar resection, while continuously visualizing the loop position on TRUS. In eight consecutive candidates with obstructive calcifications ≥3 mm, post-procedure low-dose CT confirmed clearance in every case, enabling uninterrupted continuation to the TULSA-PRO workflow. This streamlined, CT-referenced, TRUS-guided technique offers a practical pathway to preserve beam-path integrity without broad tissue debulking. The dataset of eight consecutive candidates with obstructive calcifications ≥3 mm reported here is original and has not been previously published in whole or in part.