P02 : External sphincter thermocouple monitoring dramatically reduces urinary incontinence in men undergoing primary and salvage prostate cryotherapy

Abstract

Introduction and objective Prostate cryotherapy (PC) has been studied in both the primary and salvage settings. Recent technical modifications including the use of thermocouple (TC) devices have led to an improvement in quality of life as well as prostate cancer (CaP) control. The temperature monitor in the external sphincter (ES) has been proposed to reduce urinary incontinence (UI). We were interested in determining the UI rates after PC compared with the lowest temperature achieved in the ES. Methods Ninety-one consecutive patients undergoing PC for clinically localized CaP by a single surgeon at an urban tertiary care center signed consent to be followed in this IRB-approved study. All patients had biopsy-proven CaP and underwent primary or salvage PC. 17G Single-Point Thermal Sensors and Multi-Point Thermal Sensors were used to monitor attainment of the freeze and thaw temperatures for the intended treatment protocol. Transperineal TC positioning was documented by transrectal ultrasound and cystoscopic guidance. At follow up, the number of used pads/day was ascertained through distributed Expanded Prostate cancer Index Composite surveys – a validated instrument to assess health-related quality of life in men with CaP. Results Ninety-four men underwent PC from February 2012 to September 2013; 49.5% primary focal ( n = 47), 16.8% focal salvage ( n = 16), 24.2% primary total ( n = 23), 8.4% total salvage ( n = 8). The average temperature at end of the first and second freeze cycles in the ES was 25.2 °C (with a range of 5–37 °C) and 24.4 °C (range 4–37 °C) respectively. The average patient age at time of procedure was 68 years (range 49–83 years) and average prostate volume was 34.9 cm 3 (range 12–100 cm 3 ). The leakage rate for the overall cohort, defined as >1 pad/day, at 4 months post-procedure was 5.1% ( n = 4). Of these incontinent patients, 1 underwent primary focal cryotherapy and 3 underwent focal salvage cryotherapy. Average age and ES temperatures for the first and second freeze cycles were comparable in this incontinent cohort. However, the average prostate volume (22.3 cm 3 ) for these incontinent men on a univariate analysis was significantly different from the entire cohort. Conclusions The use of multi-sensor TC devices in the ES has led to a dramatic reduction on UI post-treatment. A smaller prostate volume at the time of the procedure may be associated with an increased risk of UI. These outcomes are for an experienced surgeon; caution should be exercised in generalizing these results.