Cryoablation of the prostate.
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Cryosurgery↗
Biomedical subjects
J K Cohen
Publications and source records attributed to J K Cohen.
Urethral warming catheter for use during cryoablation of the prostate.
Cryoablation of the prostate has been shown to be a useful tool in the eradication of prostate cancer. Sloughing of necrotic tissue per urethra was one of the major complications of prostate cryosurgery during its initial application and led to its disuse by urologists. A catheter was then needed until sloughing was complete and the patient again able to void. In a previous report, we have demonstrated that thermal protection of the urethra could be obtained by flowing warm irrigant through a thin-walled urethral conduit. To simplify the application of this heat, a dual lumen urethral catheter has been designed that can be passed transurethrally to circulate warm saline and prevent the destruction of the urethral epithelium. This prevents transmural necrosis, maintaining the epithelial barrier for containment of necrotic prostate tissue after treatment. This urethral warming device is made of materials commonly found in operative stockrooms. To date, the device has functioned well with a urethral sloughing rate of 12% during its initial use.
Cryosurgery↗
Thermal protection of urethra during cryosurgery of prostate.
Cryoablation of the prostate requires adequate thermal protection of the urethra. This study describes a simple urethral warming device as well as a method of use with components readily available in hospital operating facilities. An initial clinical study as well as tests in an animal model both indicate that the use of this thermal protection device can effectively protect the urethra during the cryosurgical process.
Animals↗
Percutaneous transperineal cryosurgical ablation of the prostate for the primary treatment of clinical stage C adenocarcinoma of the prostate.
OBJECTIVES: To assess short-term response rate and local tissue destructive capabilities of cryosurgical ablation of the prostate (CSAP) in patients with clinical Stage C adenocarcinoma of the prostate. METHODS: A retrospective chart review of 62 patients (mean age, 66 years; range, 49 to 79 years) treated on an institutional review board approved protocol at Allegheny General Hospital between June 1990 and December 1993 was performed. Standard follow-up examination included serial prostate-specific antigens (PSAs), digital rectal examination, and extensive biopsies at 3 months after CSAP. RESULTS: Average hospital stay was 2 days and morbidity was minimal. Biopsy findings showed no residual detectable prostatic tumor in 79% of patients 3 months after 1 CSAP treatment and in 94.8% 3 months after 1 or 2 treatments. Mean/median 3-month postoperative PSAs for patients with negative biopsy findings were 0.59 +/- 1.66 and 0.10 ng/mL, respectively, compared with 14.0 +/- 12.1 and 8.90 ng/mL preoperatively. CONCLUSIONS: CSAP appears to produce controllable, reproducible local tissue destructive effects. Long-term (more than 5 years) crude and disease-free survival rates are not known for CSAP.
Adenocarcinoma↗
Transrectal ultrasound-guided percutaneous radical cryosurgical ablation of the prostate.
BACKGROUND: The two major treatments for prostate cancer, radical prostatectomy and radiation therapy, are associated with considerable morbidity and variable results. This article presents the preliminary results using percutaneous radical cryosurgical ablation under ultrasound guidance to treat prostate cancer. METHODS: The patient group consisted of all patients with localized prostate cancer who underwent cryosurgery between June 1, 1990 and May 1, 1992. Patients in Group 1 were treated by freezing of the tumor with two cryoprobes placed multiple times. Group 2 patients were treated by freezing of the tumor with five cryoprobes placed simultaneously. Cryoprobes (3 mm in diameter) were placed percutaneously with a transperineal approach. Cryoprobe placement and freezing were monitored using the transrectal ultrasound. RESULTS: Of the 55 patients (68 procedures) undergoing treatment, 23 have 3 months of follow-up with associated biopsy (Group 1, 8 patients; Group 2, 15 patients). In Group 1, three (37.5%) patients had residual disease. In Group 2, one (6.7%) patient had residual disease, whereas 14 (93.3%) patients did not. Combining both groups, 19 (82.6%) patients had no residual disease, whereas 4 (17.4%) patients had positive results on postoperative biopsy. Complications included rectal freezing, urethrorectal fistula, sloughing urethral tissue, impotence, perineal ecchymosis, penile edema, and ileus. CONCLUSIONS: Preliminary results indicate that percutaneous transperineal ultrasound-guided prostate cryosurgery may be an effective treatment for prostate cancer with minimal associated morbidity.
Biomarkers, Tumor↗
Ultrasound characteristics of renal cryosurgery.
The ability to visualize renal cryosurgery using ultrasound was tested in an animal model. Five dogs underwent open laparotomy and ultrasound-monitored cryosurgery of both kidneys. On each kidney two cryolesions were made. The borders of the frozen region were identified on ultrasound as a hyperechoic rim created by the interface between frozen and unfrozen tissue. The thawed cryolesion appeared hyperechoic compared with the unfrozen kidney. Excellent correlation between the ultrasound and autopsy measurements of the cryolesions was obtained. Knowing this, renal cryosurgery under ultrasound monitoring may be possible.
Animals↗
Primary endoscopic realignment following posterior urethral disruption.
We describe 5 cases in which complete posterior urethral disruption associated with pelvic fracture was managed by primary endoscopic realignment 7 to 19 days after injury. Realignment was accomplished using a flexible endoscope through the suprapubic tract and a rigid or flexible cystoscope in the distal urethra. A guide wire was passed from the suprapubic tract through the disrupted membranous urethra and out the distal urethra. A Councill catheter was left indwelling for 5 to 10 weeks. After removal a program of intermittent self-catheterization was continued for 3 months. Excellent results were obtained in 4 patients who are continent, including 2 who are potent. This technique allows considerable reduction of patient morbidity without compromising formal urethroplasty should it later be required.
Accidents, Occupational↗
Retropubic dorsal vein control during radical prostatectomy or cystectomy.
Excessive bleeding from the dorsal vein complex can be prevented during radical prostatectomy or cystectomy with a modified Van Buren sound and a suture.
Cystectomy↗
Primary transitional cell carcinoma of the prostate.
Two cases of the rare primary paramalpighien tumors of prostate, arising from the prostate gland canals lined with paramalpighien epithelium, are described and their poor prognosis due to rapid local and metastatic spread emphasized.
Aged↗
Primary transitional cell carcinoma of the prostate.
Transitional cell carcinoma of the prostate is an unusual finding usually associated with transitional cell carcinoma of the bladder. We recently treated two patients with transitional cell carcinoma of the prostate without evidence of bladder involvement. Their histories are reviewed and the literature pertinent to this entity is discussed.
Aged↗
Emphysematous cystitis.
Emphysematous cystitis is a rare clinical entity. The most commonly afflicted patients are immunocompromised and have urinary retention. Most patients appear to have diabetes mellitus. Treatments consist of establishing bladder drainage and administering broad spectrum antibiotics. Successful treatment is based on early diagnosis and prompt treatment.
Aged↗