Rd. Cespedes et al., LONG-TERM FOLLOW-UP OF INCONTINENCE AND OBSTRUCTION AFTER SALVAGE CRYOSURGICAL ABLATION OF THE PROSTATE - RESULTS IN 143 PATIENTS, The Journal of urology, 157(1), 1997, pp. 237-240
Purpose: We report long-term followup of patients with incontinence an
d obstruction after salvage cryosurgical ablation of the prostate. Mat
erials and Methods: We reviewed the records of 143 patients who underw
ent cryosurgical ablation of the prostate for treatment failure after
radiation therapy. Data were collected by telephone interview with eac
h patient and chart review. Median followup was 27 months (range 12 to
42). Results: Of 107 patients who underwent cryosurgical ablation of
the prostate using a commercially available urethral warmer 15 (14%) h
ad significant obstruction or retention that required transurethral re
section of the prostate in 10, of whom 6 became incontinent. Urinary i
ncontinence occurred in 45 patients (42%) and resolved in 21 (47%), fo
r an overall 28% long-term incontinence rate. Of 28 patients who under
went cryosurgical ablation of the prostate using an alternative urethr
al warmer 13 (46%) had incontinence and 15 (54%) had significant obstr
uction or retention. Resolution was rare and 89% of the patients are c
urrently incontinent. Eight patients underwent 2 separate cryosurgical
ablations with an 88% incontinence rate (43% overall). The double fre
ezing technique did not increase postoperative obstruction or incontin
ence. Conclusions: Incontinence and urinary retention rates are increa
sed in patients undergoing cryosurgical ablation of the prostate after
failure of radiation therapy but spontaneous resolution occurs in hal
f of the patients within 1 year if an effective urethral warmer is use
d. Incontinence treatments should be delayed until after this period.
Postoperative incontinence and obstruction rates are significantly gre
ater when an effective urethral warmer is not used and spontaneous res
olution is rare.