Source: 1999 American Urological Association Meeting

Transurethral Ethanol
Ablation of Prostate

Richard A. Watson, Pratik Patel, and Joseph V. DiTrolio (Presented by Dr. DiTrolio).

INTRODUCTION AND OBJECTIVES: Absolute alcohol has been used successfully for tissue ablation and nerve blockade over several decades. Studies have proven that absolute alcohol, when injected into prostatic tissue in animal models, creates tissue necrosis similar to that created by thermal therapy. Building on these research experiences and using a patented transurethral injection device, we have demonstrated the tissue effect of transurethral, intraprostatic, ethanol injection into in-vivo, human prostates.

MATERIALS AND METHODS: Ten male patients, for whom open, simple prostatectomy had been scheduled for benign, obstructive disease, consented to transurethral injection of absolute ethanol into the prostate, from five to ten days prior to their scheduled surgery. Transurethral injections were made into the lateral lobes and, if necessary, into the middle lobe. Our newly developed transurethral device has been specifically designed for submucosal placement, with multiport prostatic infusion using a standard cystoscope. A Foley catheter was left in place for twenty-four hours, after which all patients were able to void. At the time of open prostatectomy, care was taken to remove the adenoma intact. Serial sectioning was performed to evaluate tissue changes.

RESULTS: Transurethral intraprostatic injection of absolute ethanol resulted in an ovoid defect, with sclerosis and necrosis of obstructive prostate tissue. All lesions were well demarcated, and ethanol-induced necrosis did not extend to the prostatic capsule or sphincter.

CONCLUSION: Absolute ethanol has been used for years effectively as an injectable sclerosing and necrosing agent. It is approved for intracorporeal use, readily available and inexpensive. The low cost of this material, in conjunction with its demonstrated ability to effect selective destruction of obstructing tissue, comparable histologically to that achieved by current thermal techniques, suggests that this modality of treatment may serve as a reasonable option in the treatment of prostatic hypertrophy. Future studies with absolute ethanol as a sole modality will evaluate the clinical benefit of this treatment.