Source: 1999 American Urological Association Meeting
Ablation of Prostate
Richard A. Watson, Pratik Patel, and Joseph V. DiTrolio (Presented by
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.