Trans-rectal Ultrasound-Guided Autologous Blood Injection in the Interprostatorectal Space Prior to Percutaneous MRI-Guided Cryoablation of the Prostate

Abstract

Haemoprotection may create a safe and effective virtual space between the prostate and rectum.

Percutaneous MR-guided whole-gland prostate cancer cryoablation: safety considerations and oncologic results in 30 consecutive patients

“…27,28 The template allows easier probe positioning, better probe stability and reliable probe spacing. Thus with easier probe positioning, improved cryo-probe technology and MR-fluoroscopic sequences (particularly T2 TrueFISP, permitting accurate needle positioning), and evolving thermoprotective techniques (interprostato-rectal space hemodissection and urinary sphincter thermometry, 18 operator confidence to perform procedures time-efficiently and safely increased over the study period. Additional external urinary sphincter thermoprotection using hydrodissection below the prostatic apex is planned for future cases without apical tumor involvement, to minimize local freezing and hopefully reduce urinary morbidity.…”

“…A variety of thermoprotective techniques were utilized throughout the study to protect the rectal wall through hydro-/ hemo-dissection of the recto-prostatic space (Figure 1), 18 and the urethral sphincter (Table 2); external urinary sphincter thermometry was performed by positioning a transurethral thermocouple at the level of the prostatic apex. Urethral and rectal warming catheters were continuously flushed with warm saline during freezing.…”

Percutaneous MR-guided prostate cancer cryoablation technical updates and literature review

“… 25 On the contrary, in MR guided interventions, this space can even be widened during the procedure in order to ensure the optimal protection of the rectal wall. 26 …”

“…Following ultrasound-guided hemodissection of the Denonvilliers' fascia to reduce the risk for CA-mediated injury of the anterior rectal wall, the patient is transferred to the MRI room. 26 After a first multiplanar T 2 WI assessment of the gland, several cryoprobes are inserted trans-perineally through a rigid grid placed on a dedicated device (Uni-Lift Prostate Intervention Device,NORAS GmbH, Höchberg, Deutschland). The probes are spaced away 1 cm one from the other and are 5 mm within the capsule.…”

“…A way to optimize the interprostatorectal space has been recently described by Garnon et al ( Figure 1 ) and it may also be feasible to perform dissection of the prostate apex from the external urethral sphincter. 26 …”