研究目的：高能量聚焦超音波已得知可造成攝護腺組織的凝血性壞死，但有多篇報告呈現出不同的結論。我們以Sonablate-200機型評估研究臺灣地區攝護腺肥大的病患以高能量聚焦超音波治療後之效果及其安全性。材料與方法：西園醫院自1999年3月至2001年4月共計有121位病患實施經直腸高能量聚焦超音波治療攝護腺肥大。32位病患做完治療卻排除於本研究之外；其排除原因：腺體過大、未經察覺的尿道狹窄、膀胱結石、膀胱內腺體突出及惡性腫瘤。共有89位攝護腺肥大的病患適合且包括於此研究之內，我們定期追蹤所有病患之國際攝護腺症狀評分（IPSS）、生活品質指數（QOL）、最高尿流速（Qmax）、排尿後的餘尿量（RU）及血液中攝護腺癌特殊抗原（PSA）。另有22位病患於術後9個月時追蹤經直腸攝護腺超音波（TRUS）測量腺體大小與術前比較。所有病患平均追蹤10.11±6.24（3至24）月。結果：40位病患的資料完整追蹤12個月且數據具有統計意義（p<0.005），Qmax從9.32±3.18ml/s上升至15.6±4.49ml/s（40.3%）。IPSS自21.63±6.28降至11.85±6.05（45.5%）。平均餘尿量由64.93±64.31ml減至24.10±19.86ml（p=0.0001）。近五成病患出現短暫性的手術併發症如：術後急性尿滯留、血尿、精血症、副睪丸發炎、逆行性射精或精液量減少。另有兩例嚴重之手術併發症；一是尿道直腸廔管，發生於覆發性攝護腺肥大的心臟病患者。其廔管在連續4個月的導尿管放置後自動癒合。另外一例是嚴重會陰部疼痛，核磁共振檢查（MRI）發現明顯擴大且發炎的儲精囊。結論：我們的經驗認為，經直腸高能量聚焦超音波治療攝護腺肥大是一相對安全、容易操作且可以達到一定效果之治療方式。

OBJECTIVE: Experimental studies have shown clear damage to prostate tissue when ex-posed to high-intensity focused ultrasound, but different results of in vivo effects have been reported by many centers. We study the safety and efficacy of HIFU in benign prostatic hyperplasia patients in Taiwan using a modified Sonablate-200 device. MATERIAL AND METHODS: From March 1999 to April 2001, a total of 121 patients suffering from symptomatic BPH received transrectal HIFU treatment under regional anesthesia with the Sonablate-200 device. Thirty-two patients who completed the treatment were withdrawn from the data analysis for various reasons, including large glands and presence of previously undetected stricture, bladder stone, intravesicle tissue bulging, and malignant disease. Eighty-nine patients were eligible for the study. Data of the International Prostate Symptom Score, quality of life, peak flow rate, post-void residual volume, and serum PSA level were collected before and after treatment at regular time intervals. A transrectal prostate sonogram was performed in all cases before treatment, and in the frist 22 cases at 9 months after treatment. The mean follow-up period was 10.11±6.24(3 to 24) months. RESULTS: Data from 40 patients with complete 12-month follow-up were analyzed. Mean peak flow rate increased from 40 patients with complete 12-month follow-up were analyzed. Mean peak flow rate increased from 9.32±3.18 to 15.6±4.49ml/s(40.3%,P=0.0001). Mean IPSS decreased from 21.63±6.28 to 11.85±6.05(45.5%,p=0.0001). Mean residual volume dropped from 64.93±64.31 to 24.10±19.86 ml (p=0.0001). In half of the patients, minor transient complications were encountered, including acute urinary retention after Foley removal in 10 patients (11.2%) hematuria in 18(20.2%), hematospermia in 15(11.2%), epididymitis in 13(14.6%), and decreased volume of ejaculate in 17(16.8%). Two major complications occurred. Urethrorectal fistula developed in a patient who had received TURP 8 years previous. The fistula healed after long-term catheterization for 4 months. Another patient complained of severe deep pelvic pain. MRI revealed inflammatory change and dilatation of the seminal vesicle. The pain was managed with analgesics. No further surgical procedure was required in either case. CONCLUSIONS: Our experience indicates that transrectal HIFU is safe, easy to implement, and effective in achieving satisfactory results.