Saline Displacement of Rectal Wall for Improved Margin During MRI-Guided Transurethral Ultrasound Ablation (TULSA)

MRI-guided transurethral ultrasound ablation (TULSA) is an effective treatment for prostate cancer, but proximity to the rectum presents a challenge for ablation margin. We report the first case using saline infusion to displace the rectal wall during TULSA, allowing for improved treatment margins while minimizing rectal risk. A 67-year-old male with a Gleason score 3 + 4 = 7 lesion underwent right hemiablation with saline infusion achieving 5.3 mm displacement. Post-procedure imaging showed no rectal injury, and follow-up revealed no complications or recurrence. This novel technique demonstrates the safety and feasibility of saline displacement to enhance ablation coverage, offering a promising solution for treating lesions near the rectum.