INTRODUCTION AND OBJECTIVES: To evaluate whether splitting TURP and Hifu in two session can reduce complication rate in patients with localized prostate cancer. METHODS: From November 2004 to September 2010, 103 patients affected by localized prostate cancer underwent HIFU following TURP. In 39 patients both procedures were performed in the same session (Group A); in 64 patients HIFU was delayed (Group B). Follow up included serial PSA measurements and prostate biopsies 6 months after the treatment in all patients. Biochemical recurrence was defined as PSA nadir 2ng/ml (ASTRO 2005 criteria). We have evaluated complication rate in the Group A and B. RESULTS: The mean age, PSA and prostate volume were 73.3 ( 5.4) years, 8.2 ( 19.3) ng/ml and 29 ( 8,3) cc, respectively. Mean procedure time was 128 minutes and mean hospitalization was 3.4 days. Complications occurred in 30 patients. Complication rate was not associated with clinical stage (T1 vs T2) (p0,67), Gleason score (p0,62), age (p0,2), prostate volume (p0,06), PSA (p0,9). Complications rate was lower when HIFU has been delayed after TURP (Group B) [see table]. Complications occurred in 61% (24/39) of Group A patients and in 9,3% (6/64) of Group B patients (p 0,001). No significant differences were seen between Group A and B patients in terms of clinical stage (p0,9), Gleason score (p0,2), prostate volume (p0,3), age (p0,4) and PSA (p0,46). CONCLUSIONS: Splitting TURP and HIFU in two different sessions seems to reduce postoperative complications and improve patient tolerance of the procedure. Longer follow up and larger patient population are needed to obtain more robust evidence.