Active hydrodissection might optimize cryosurgical ablation of the prostate.
OBJECTIVE
To produce lower temperatures safely in the prostate, and better protect the rectum , as well as maximize the technique of cryosurgical ablation to better eradicate prostate cancer.


METHODS
A total of 10 consecutive patients underwent total, subtotal, or focal cryosurgical ablation, with saline hydrodissection. We found lethal prostate temperatures and safer rectal temperatures. One patient developed a very small rectourethral fistula that healed with catheter drainage alone, prompting a revised technique. The prostate-specific antigen values at short follow-up were very low.


RESULTS
Temperatures of -10°C to -76°C were achieved outside the prostate at the neurovascular bundle. Post-operative prostate-specific antigen values were 0.10 to 3.4 if total or focal therapy, respectively, was used. A small rectal fistula healed with catheter drainage alone.


CONCLUSIONS
This technique appears to hold great promise and should be investigated further in a larger group of patients with longer follow-up.
Department of Urology, Hackensack University Medical Center, Holy Name Hospital, Teaneck, New Jersey, USA. drgrose@aol.com
Gene S
GS
Rosenberg
Kevin G
KG
Basralian
D000230:Adenocarcinoma / Q000097:blood / Q000601:surgery; D000328:Adult; D000368:Aged; D003080:Cold Temperature / Q000009:adverse effects; D003452:Cryosurgery / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000601:surgery; D012003:Rectal Fistula / Q000209:etiology; D012007:Rectum / Q000293:injuries; D012965:Sodium Chloride / Q000008:administration & dosage*; D013696:Temperature; D007507:Therapeutic Irrigation / Q000379:methods*; D014522:Urethral Diseases / Q000209:etiology; D014548:Urinary Fistula / Q000209:etiology
D012965:Sodium Chloride; D017430:Prostate-Specific Antigen