Introduction- The proximity of the rectum to the prostatic capsule has major implications to the safe effective application of prostate cryosurgery. Freezing of the rectum results in urethro-rectal fistula formation, the most dreaded of prostate cryosurgical complications. The fear of rectal freezing can result in the stopping of freezing too early with cancer recurrence as the result. In this paper we will describe a Simple procedure for increasing the space between the rectum and the prostate (injecting saline into Denonvillier's Fascia) thereby increasing the safety and efficacy of prostate cryosurgery.
Method- After placement of thermocouples and introduction sheaths a 22 gauge spinal needle is connected to an extension tubing and a 50 cc syringe filled with normal saline. Air is expelled from the system and the needle is placed into Denonvillier's Fascia under ultrasound guidance. The amount injected is determined by the ultrasound appearance.
Results- The described procedure was used in 62 cases and was successfully carried out in 61. The single failure was in a patient who had been treated with external beam radiation and brachytherapy. No complications resulted from the procedure and no instance of urethro-rectal fistula was reported. The technique allowed more extensive freezing; no positive biopsies have yet been encountered, no patient has yet needed to be retreated.
Conclusion- Results indicate that saline injection into Denonvillier's Fascia is a safe and effective means for preventing urethro-rectal fistula and increasing the efficacy of cryosurgery.