LONG-TERM FOLLOW-UP OF INCONTINENCE AND OBSTRUCTION AFTER SALVAGE CRYOSURGICAL ABLATION OF THE PROSTATE - RESULTS IN 143 PATIENTS

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.