Intraprostatic ethanol diffusion: comparison of two injection methods using ex vivo human prostates

Area of Science:

• Urology
• Biomedical Engineering
• Surgical Innovation

Background:

• Intraprostatic ethanol injection for benign prostatic hyperplasia (BPH) has shown variable outcomes in clinical trials.
• Ethanol backflow along the needle tract is a key factor limiting treatment efficacy.
• Convection-enhanced delivery (CED) has previously demonstrated potential to mitigate backflow and improve ethanol distribution in animal models.

Purpose of the Study:

• To compare the ethanol distribution pattern between a microporous hollow fiber catheter (MiHFC) and a standard needle in human prostates.
• To evaluate the feasibility of using freshly harvested human prostates for assessing intraprostatic injection techniques.

Main Methods:

• Human prostates were harvested from organ donors immediately post-mortem.
• Absolute ethanol was injected into one lobe using a standard 21-gauge needle and into the contralateral lobe using a MiHFC.
• Prostates were fixed, sectioned, and stained for 3D reconstruction to determine lesion volume.

Main Results:

• The MiHFC resulted in significantly larger ethanol-induced lesions (1.14±0.52 cm³) compared to the standard needle (0.28±0.10 cm³).
• No ethanol backflow was observed when using the MiHFC.
• The study demonstrated the successful use of freshly harvested human prostates for evaluating injection techniques.

Conclusions:

• Freshly harvested human prostates are a viable model for evaluating intraprostatic injection treatments.
• The MiHFC significantly enhances ethanol distribution and lesion size compared to standard needles.
• MiHFC represents a promising delivery system for intraprostatic ethanol injection therapy for BPH.