ULTRASOUND-GUIDED CRYOPROSTATECTOMY - A POTENTIAL ALTERNATIVE TO TRANSURETHRAL PROSTATIC RESECTION IN THE HIGH-RISK PATIENT

Various alternatives to transurethral prostatectomy in the high-risk p atient have been described and evaluated, but none has yet achieved wi despread acceptance. Cryosurgical prostatectomy has fallen out of use due mainly to the consequences of the inability of the operator to con trol the extent of freezing. On the basis of experimental studies sugg esting that real-time ultrasound could be used to monitor the procedur e, we undertook a study of it in 12 high-risk patients (ASA grades 3 a nd 4, mean age 80.33 years). Using a liquid nitrogen-cooled urethral p robe, patients' prostates were cooled to -160-degrees-C, with a transr ectal ultrasound probe in situ to monitor the iceball. Two patients re quired post-operative transfusion for haemorrhage and two developed sy mptomatic urinary tract infection. After 6 months, one patient who pre sented with chronic retention of urine is required to carry out clean intermittent self-catheterization. The remaining 11 patients all had a good result, both symptomatically and as shown by measurements of flo w rates. This study demonstrates that real time ultrasonic monitoring of cryoprostatectomy is possible and suggests that this method of pros tatectomy in poor risk patients deserves re-evaluation.