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Achieve the Trifecta: Cancer Control, Continence, Potence.
Dr. Koushik Shaw has helped diagnose and successfully treat men with prostate cancer from the Austin, Texas area and beyond using advanced techniques that not only fight the disease, but preserve erectile function and urinary continence.
The HIFU procedure has reduced surgical times to two hours in most cases and a vast majority of patients are able to be discharged hours after the procedure with minimal discomfort. Studies show HIFU can lead to lower complications and faster recovery.
Benefits include no incisions or blood loss, a quick recovery, and no radiation required. HIFU allows Dr. Shaw to perform tumor ablation in a manner that optimizes prostate cancer control, is nerve-sparing for preservation of potency, and preserves critical structures to optimize urinary control. We call this the “Trifecta of Success.” Cancer Control. Continence. Potence.
High Intensity Focused Ultrasound is performed under general anesthesia. After sedation, an ultrasound probe is placed into the rectum and the prostate is imaged. The urologist will map an outline of the prostate using ultrasound imaging to determine the areas of the prostate to be treated. The ultrasound probe is then used to focus high-intensity sound waves toward particular areas of the prostate determined to be cancerous. When treatment starts, 400 to 600 pulses of high intensity ultrasound are then administered to the prostate. This process is repeated, over the whole area of that prostatic tumor, until all of the cancerous tissue has been destroyed. On average, a patient will be in surgery between 2-4 hours.
HIFU treatment has been under development for nearly 30 years, approaching 50,000+ treatments world-wide.
HIFU treatment involves active ultrasound monitoring of the prostate, targeting the area of cancer, and initiating focal treatment in a targeted manner sparing vital structures including nerves for erection, the bladder, and continence musculature.
HIFU results in targeted tissue destruction at a cellular level.
The latest generation technology is utilized.
Extent of cancer treatment is pre-planned based on MRI and prostate biopsy data, and discussion regarding patient expectations and outcomes
HIFU remains a valuable tool in the management of prostate cancer with worldwide data and FDA approval
We will start with a phone or video consultation to review your case. This includes review of your PSA, your prostate biopsy results, family, medical, and surgical history, and your continence and potency expectations.
If you are found to be a good surgical candidate, we will reserve you a surgical date, typically performed on Tuesdays. We will have you fly or drive into Austin on a Friday before your surgery for an in-person visit, as well as coordinating MRI imaging studies if needed, which will assist us with intraoperative mapping of the prostate to optimize nerve sparing for preservation of continence, potency, and optimizing a cancer-free outcome.
If flying into Austin, we are happy to coordinate car-service from the airport to one of several nearby hotels within three miles of the Austin Urology Institute, with whom we have negotiated affordable rates.
We typically remove the foley catheter that is placed intra-operatively 5 after surgery. The first PSA check should be done with us, or in the patient’s home town, six weeks postoperatively. Using our telemedicine capabilities, we can also perform postoperative checks and follow ups remotely.
We often recommend use of daily 5mg Cialis postoperatively to help with accelerated recovery of the nerves for regaining erectile function.
Dr. Koushik Shaw has practiced for more than 15 years, having taken care of thousands of prostate cancer patients.
Dr. Shaw is proud to be part of the St. David’s North Austin Medical Center and the Texas Institute for Robotics Surgery, one of the largest centers for daVinci Robotic Surgery in the world and winner of the prestigious Malcolm Baldridge Award for operational excellence. We are also proud to have been Austin Monthly’s “Urologist of the Year” for several years. That, along with our 5-star rated, world-class Austin Urology Institute facilities, recognized for friendly, patient-centered care, is the reason that patients find us to be the doctor and facility of choice for treatment of their prostate cancer.
Most patients report minimal pain. Minor discomfort is associated with a catheter, which is placed into the bladder under anesthesia.
The catheter allows continuous drainage of the bladder into a small external collection bag which is emptied as needed. Do not try to remove this catheter on your own. It must stay in place until you heal enough that it is no longer needed.
Since you will not be cleared to drive yourself, you will need someone to drive you home.
Immediately after surgery, your abdomen will be slightly bloated so you may have trouble fitting into your regular clothes. For comfort, wear loose fitting clothing such as sweatpants or other pants with elastic (not button) waistbands. You will probably need to do so initially anyway to accommodate the catheter and collection bag.
You may start showering the day of your discharge. The catheter collection bag may be removed during showering. Gently pull the colored catheter straight off of the clear plastic tubing from the bag and allow urine to run into the shower. After showering, gently pad the suture sites (do not rub or otherwise irritate them) with a towel.
The sutures utilized will dissolve on their own, so there is no need to have them removed. Skin glue is often used, and should gradually flake off like a sunburn. A small amount of redness at the edges of the incision sites, as well as a small amount of clear or bloody leakage from the wound, is acceptable. Drainage of sufficient quantity to soak dressings, or redness greater than 1/2 inch from the incision should be reported to the physician.
Some men may have mild slowness of urination immediately after HIFU. You will be given a medication such as Flomax/Alfuzosin/Uroxatral/Tamsulosin to take for one month postoperatively to help with this. You will NOT experience incontinence as a result of HIFU.
HIFU may result in a transient decrease in erectile function, if any change is noted at all, but it should not prevent you from having a fulfilling sex life when you recover. There are three components to sexual function in men: sexual drive, sensation, and erection/climax (orgasm). We often will start patients on a sexual rehabilitation program to ensure that erectile function is maintained. This may also involve optimizing Testosterone levels when needed.
Abdominal Distention, Constipation or Bloating: Make sure you are taking your stool softener as directed, and drinking prune juice or milk of magnesia. If you still haven’t had a bowel movement 48 hours after surgery, you may take an over-the-counter suppository such as Dulcolax.
Bladder Spasms: Bladder spasms are typically associated with a sudden onset of lower-abdominal discomfort, a strong urge to urinate, or with sudden leakage of urine from around the catheter. If they are a big problem, contact the office, as we can prescribe a medication for you.
Bloody Drainage Around The Foley Catheter Or In Urine: Under stress, such as during physical activity or bowel movement, this is not uncommon immediately after surgery. This should improve if you cease activity and rest for a short while. If it does not, or if you see clots in your urine or have no urine output for two hours, contact your physician.
Perineal Discomfort (pain between your rectum and scrotum): This may last for several weeks after surgery, but it should resolve on its own. If you are suffering significant pain despite pain medication, contact your physician. You might also try elevating your feet on a small stool when you have a bowel movement, applying hemorrhoid ointment, and increasing the fiber and water intake in your diet.
Scrotal/Penile Swelling and Bruising: This is not abnormal and is not cause for serious concern. You might notice scrotal/penile swelling anywhere from immediately after surgery to 5 days later. It should go away on its own in a week or two. You might try elevating your scrotum on a small rolled up towel when you are sitting or lying down to reduce swelling. Also, wearing supportive underwear (briefs, not boxer shorts) is advisable.