Pilot study of transperineal injection of dehydrated ethanol in the treatment of prostatic obstruction

Objectives. To evaluate the efficacy of a new approach for treatment of prostatic obstruction involving transperineal injection of dehydrated ethanol into the prostate using transrectal ultrasound (TRUS). Methods. Dehydrated ethanol was injected transperineally into 11 patients with prostatic obstruction due to hyperplasia or carcinoma. Injections were performed under TRUS surveillance at bilateral sites of the prostate for an overall amount of 2 to 8 mL of ethanol for each patient. Results. There were no intraoperative complications, but postoperative urinary retention occurred in 1 patient who received catheterization for 3 days. The mean symptom score decreased from 17.7 ± 6.0 (median 23) to 8.5 ± 1.1 (median 3.5) at 3 months postoperatively (P < 0.01); mean peak urine flow rate increased from 5.3 ± 4.0 mL/s (median 7) to 13.5 ± 3.6 mL/s (median 14) (P < 0.05); and mean residual urine volume decreased from 231.9 ± 209.8 mL (median 108) to 28.7 ± 13.7 mL (median 34) (P < 0.01). There were no significant differences at 6 months when the same parameters were assessed. Pathologic findings for 2 patients with prostatic obstruction due to carcinoma showed only granulation tissue, with no evidence of malignancy in the treated area. Conclusions. Our preliminary data suggest that this technique can be performed as an outpatient procedure. It is considered an alternative treatment for prostatic obstruction due to benign hyperplasia or carcinoma, especially when there is a high operative risk.