Ultrasound-guided cryoprostatectomy - a potential alternative to transurethral prostatic resection in the high risk patient

Various alternatives to transurethral prostatectomy in the high-risk patient have been described and evaluated, but none has yet achieved widespread acceptance. Cryosurgical prostatectomy has fallen out of use due mainly to the consequences of the inabil ity of the operator to control the extent of freezing. On the basis of experimental studies suggesting that real-time ultrasound could be used to monitor the procedure, we undertook a study of it in 12 high-risk patients (ASA grades 3 and 4, mean age 80.33 years). Using a liquid nitrogen-cooled urethral probe, patients' prostates were cooled to −160°C, with a transrectal ultrasound probe in situ to monitor the iceball. Two patients required post-operative transfusion for haemorrhage and two developed symptomatic urinary tract infection. After 6 months, one patient who presented 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 flow rates. This study demonstrates that real time ultrasonic monitoring of cryoprostatectomy is possible and suggests that this method of prostatectomy in poor risk patients deserves re-evaluation.