Levator Ani Necrosis: An Exceptional Complication Occurring after “High Intensity Focused Ultrasound” of the Prostate

Table 1

Pelvic MRI follow-up after HIFU.

Time	Prostate	Bladder	Muscles
Before HIFU	Normal size.; Normal borders and capsule.; Left lobe tumor with abnormal contrast uptake.	Mild parietal hypertrophy	Normal
2 months after HIFU	Small size.; Slightly irregular borders.; Central necrosis.	Bladder neck enlargement	Levator ani muscle necrosis extending to the right interprostatorectal space
6 months after HIFU	Small size.; Slightly irregular borders.; Central necrosis.	Normal	Regression of the necrosis between the internal obturator and rectum. Persistence of the necrosis at the level of the left levator ani
3 years after HIFU	Small size.; Slightly irregular borders.; Central necrosis.	Normal	Normal puborectalis and sphincter muscles.; Marked regression of the levator ani necrosis
6 years after HIFU	Abnormal contrast uptake in the left lobe.	Normal	Normal. No sign of levator ani necrosis

HIFU: high intensity focal ultrasound; MRI: magnetic resonance imaging.