Histoblast: A Novel Cavitative High-Intensity Focused Ultrasound (HIFU)-Modified Technique for Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a prevalent condition, often requiring intervention due to its impact on quality of life. High-intensity focused ultrasound (HIFU) has demonstrated efficacy in prostate cancer treatment; however, its application in BPH remains limited by prolonged treatment times and delayed symptom relief. This report introduces a novel HIFU-based technique (Histoblast) using the Sonablate 500® (SB-500) system to improve treatment efficiency and clinical outcomes in BPH. Key modifications to the conventional HIFU approach include: (1) a checkerboard treatment pattern to reduce treatment time (TT) and tissue edema; (2) prostate compression via increased degassed water volume to minimize heat dissipation and enhance acoustic efficiency; and (3) optimized energy delivery within the upper third of the device's approved range. Treatment progress is monitored using standard safety parameters, including Tissue Change Monitoring and Reflectivity Index measurements. The procedure is performed under spinal anesthesia, with postoperative catheterization lasting approximately four days. This technique reduces the number of treatment shots by 40-50%, achieving a significantly shorter TT. Controlled acoustic cavitation is observed in up to 70-75% of treated zones, indicating effective tissue ablation. Preservation of the urethra and bladder neck is prioritized to facilitate early catheter removal. This technique represents a promising refinement of HIFU for BPH management and warrants further clinical evaluation.