Like all treatments, HIFU can cause side effects. These affect each man differently, and you might not get them all.
The most common side effects are urinary problems and difficulty getting and keeping an erection (erectile dysfunction).
You’re more likely to get side effects if you have repeat HIFU treatment or if you have already had other treatments for prostate cancer. This is because these treatments might have already caused some damage to the area around the prostate.
Ask your doctor or nurse for more information about side effects. They should be able to show you the results of the treatments they have carried out and put you in touch with other men who've had the treatment.
Short-term side effects
These can develop soon after your treatment.
You might notice blood in your urine while the catheter is in place. You might also notice some small pieces of prostate tissue in your urine for up to two months after your HIFU treatment. This is normal, but you should contact your doctor or nurse straight away if you are worried or if you develop any new symptoms such as pain or a high temperature.
HIFU can make your prostate gland swell temporarily. This might make it hard to pass urine for a short while after your catheter has been removed. If you notice your flow of urine has slowed down or you are unable to urinate, you should get treatment straight away. Contact your doctor or nurse or go to your hospital accident and emergency (A&E) department.
They might suggest a temporary catheter until the swelling has settled. This is a tube that you can use to drain urine from your bladder whenever you need to go to the toilet.
Some men get a urine infection after treatment. If you have a urine infection, you might need to urinate more often and with less warning and you might get a burning feeling when you urinate. Other signs of a urine infection include a high temperature, burning sensation or dark, cloudy or unpleasant smelling urine. Your doctor can prescribe antibiotics to treat a urine infection.
Longer-term side effects
Most short-term side effects will settle down after your HIFU treatment, but you can have later and long-term side effects.
HIFU can cause urinary problems. These include leaking urine, and problems passing urine. You may have symptoms straight after treatment, or they might develop some time later. Research suggests that if you have a large prostate, having a TURP operation before HIFU treatment might reduce the risk of having problems urinating. This is because the TURP operation removes any parts of the prostate that are pressing on the tube which you pass urine through, making it easier to urinate.
Some men find it hard to urinate after the catheter is removed. This can sometimes be a longer-term problem caused by the urethra or the opening from the bladder getting narrower. If this becomes a problem, you might be offered a minor procedure to stretch the narrowed area.
Some men find they leak urine (urinary incontinence) after HIFU. This is more likely if you have HIFU after external beam radiotherapy. You might find that you leak a little bit when you cough, sneeze or exercise. Or you may need to go more often or more urgently.
Talk to your doctor, or nurse or GP if you have any of the side effects described above. There are a number of things that can help you manage urinary problems, including lifestyle changes, pelvic floor muscle exercises and treatments. Your doctor or nurse may be able to suggest some practical things you can do to make things easier. They may also refer you to an NHS continence service, run by nurses and physiotherapists who specialise in urinary problems.
Some men have problems getting an erection (erectile dysfunction) after HIFU treatment. HIFU can damage the blood vessels and nerves that control erections. There are treatments available to help manage erection problems.
Also after HIFU, some men ejaculate less semen, or no semen at all. But they can still orgasm (climax). This could mean that you can’t have children after treatment. If you are planning to have children, you might be able to store your sperm before the operation for use in fertility treatment. If this is important to you, ask your doctor or nurse if this option is available locally.
If you’ve had a TURP operation before HIFU, you may find that when you orgasm, the semen travels backwards into the bladder rather than out through the penis. It’s then passed out of the body the next time you urinate. This is called retrograde ejaculation. It’s not harmful and shouldn’t affect your enjoyment of sex, but it might feel quite different from the orgasms you are used to.
Talk to your doctor or nurse if you have any sexual problems. They can discuss with you possible treatment options for erection difficulties and they can prescribe treatment free on the NHS. You can also ask your doctor, nurse or GP to refer you to your local erectile dysfunction (ED) clinic.
Some men get a burning sensation or some bleeding from the back passage after HIFU treatment.
Very rarely, HIFU causes a hole (fistula) between the urethra and the back passage. This affects less than 1 in 100 men (1 per cent). It is more common, but still rare, for men who have already had radiotherapy. Recent studies suggest that about 3 out of 100 men (3 per cent) who have HIFU after external beam radiotherapy develop a fistula.
Sometimes pain and infections of the urethra can be early signs of a fistula, although these can also be caused by something else. Contact your doctor or nurse if your urine is strong smelling or you have a temperature, which could be signs of an infection. Discharge from the urethra or discharge or diarrhoea from the back passage may also be signs of a fistula. If you develop a fistula, you will need to have an operation to repair the hole.