Transurethral ethanol injection for prostatic obstruction: an excellent treatment strategy for persistent urinary...

To evaluate the efficacy of transurethral ethanol injection into the prostate (TUEIP) for patients with persistent urinary retention resulting from benign prostatic hyperplasia or advanced prostate cancer.

Twenty-one Japanese men (elderly or at high risk anesthesiologically) who had developed persistent urinary retention because of benign prostatic hyperplasia or advanced prostate cancer were treated with TUEIP from January 2001 to January 2005. Patient age and preoperative prostate volume was 64 to 92 years (median 84) and 24.1 to 125 cm3 (mean 57.6), respectively. Under sacral or lumbar anesthesia, 6 to 14 mL (mean 10.6) of dehydrated ethanol (mean ratio for prostate volume 22.7%) was injected into the prostate under endoscopic guidance, followed by placement of an indwelling catheter.

Of the 16 patients with benign prostatic hyperplasia and 5 with advanced prostate cancer, 14 (87.5%) and 3 (60%), respectively, were able to void spontaneously after catheter removal. The catheter had been left in place for 7 to 37 days (mean 12.4) after surgery. No additional treatment was required during the 2 to 24 months (mean 16) of follow-up. The postoperative residual urine volume of these 17 patients was 20 to 150 mL (mean 60) and their mean prostate volume had decreased from 52.7 to 37.9 cm3 (28.1% reduction) at 6 months postoperatively (P <0.001). No major complication was experienced.

In patients with persistent urinary retention due to prostatic obstruction without severe complications, TUEIP removes the need for catheterization and allows spontaneous voiding. TUEIP may be an alternative to transurethral resection of the prostate for high-risk or elderly patients who cannot tolerate surgery.