Efficacy and Safety of Ultrasound-guided Transrectal Ethanol Injection for the Treatment of Benign Prostatic Hyperplasia in Patients With High-risk Comorbidities: A Long-term Study at a Single Tertiary Care Institution

Abstract

To evaluate the efficacy and safety of ultrasound-guided transrectal ethanol injection for the treatment of benign prostatic hyperplasia (BPH) in patients with high-risk comorbidities. Seventy patients with BPH who showed poor oral drug efficacy and were medically fragile or unwilling to undergo operative therapy were enrolled in the study. They received ultrasound-guided transrectal ethanol injection and were followed up at 1, 3, 6, 12, and 24 months post-treatment. Volume and pathology of the prostate were observed. International prostate symptom score, quality of life, maximum urinary flow rate (Qmax), and postvoid residual volume were determined. The clinical complications were also recorded. After 24 months of treatment, prostate volume, international prostate symptom score, quality of life score, and postvoid residual of patients were significantly reduced when compared with the pretreatment values (55.9 ± 16.7 vs 46.8 ± 8.1 mL, 29.3 ± 6.7 vs 9.8 ± 2.4 points, 5.3 ± 1.7 vs 1.9 ± 0.7 points, and 130.8 ± 71.5 vs 25.9 ± 12.0 mL, respectively, P<.05). Qmax significantly increased to 15.3 ± 3.2 mL/s than the pretreatment Qmax of 4.7 ± 3.1 mL/s (P= .001). Four of 36 patients who received a high dose of ethanol developed liquefaction necrosis and urinary tract injury (2 patients each). However, the subsequent 34 patients received a reduced dose of ethanol and had no complications. The minimally invasive technique of ultrasound-guided transrectal ethanol injections showed good efficacy with few complications for the treatment of patients with BPH and other high-risk comorbidities.