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Benign prostatic hyperplasia: US-guided transrectal urethral enlargement with radio frequency--initial results in a
S N Goldberg1, P F Hahn, F J McGovern
1Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Purpose:
To enlarge the prostatic urethra with thermal coagulation with transrectal radio-frequency (RF) application in dogs.
Materials And Methods:
Eight aged dogs underwent RF ablation of periurethral prostatic tissue for 6 minutes. Eighteen-gauge electrodes were placed into the periurethral tissues with a transrectal approach and ultrasound (US) guidance. Prostatic and rectal temperatures were measured during RF application. US, conventional and computed tomographic (CT) retrograde urethrography (RUG), and CT were performed immediately (n = 8) and at 3-96 days (n = 6) after ablation. Histopathologic analysis was performed at sacrifice immediately (n = 2), at 28 days (n = 2), or at 3 months (n = 4) after treatment.
Results:
All procedures were successful with no complications and were performed in less than 30 minutes. Rectal mucosal temperature did not exceed 38 degrees C. Immediately after treatment, CT and US demonstrated 1.2-cm foci of altered periurethral tissue that corresponded to solid coagulated tissue at histopathologic analysis. By day 3, CT, RUG, and US demonstrated that these foci had begun to cavitate, resulting in enlargement of the urethra. Complete cavitation was demonstrated by day 28. Minimal reduction in the degree of urethral enlargement was noted by day 60, but narrowing, urethral strictures, or fistulas were not observed at 3 months. At histopathologic analysis, focal cavitary enlargement with at least doubling of the urethral diameter and with normal urothelium was noted in all dogs surviving at least 28 days.
Conclusion:
Transrectal RF urethral enlargement is feasible and safe in animals and merits investigation for alleviating urethral obstruction due to benign prostatic hyperplasia.