CHEMO-ABLATION OF THE PROSTATE WITH DEHYDRATED ALCOHOL FOR THE TREATMENT OF PROSTATIC OBSTRUCTION J. DITROLIO, P. PATEL, R. A. WATSON AND R. J. IRWIN, JR. From the Division of Urology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark and Roseland Surgical Center, Roseland, New Jersey ABSTRACT Purpose: We confirmed clinically whether chemo-ablation of the prostate with absolute ethanol may be an innovative transurethral approach for the relief of obstructive benign prostatic hyperplasia. Methods: Using the InjecTx endoscopic device (Injectx Inc., San Jose, California) an initial cohort of 15 patients, including 13 who have now been followed more than 1 year, underwent elective transurethral chemo-ablation of the prostate. Results: Preoperative and postoperative comparisons of the American Urological Association symptom score, maximum urine flow rate and prostatic volume reveal significant improvement with minimal discomfort and no major complication. Conclusions: The InjecTx technique proved encouragingly successful in this initial small-scale clinical trial. KEY WORDS: prostate, ethanol, prostatic hyperplasia, endoscopy, surgical equipment Traditionally transurethral prostate resection has been the gold standard treatment for benign prostatic hyperplasia (BPH). Since the early 1990s, medications such as -blockers, finasteride and more recently various new, minimally inva- sive procedures, including laser ablation and microwave therapy, have also been used. The goal of these new treat- ments for BPH has been to achieve less invasively than transurethral prostate resection significant clinical relief, while proving cost-effective and precluding the troublesome complications and side effects of transurethral prostate re- section, such as major hemorrhage, the transurethral pros- tate resection syndrome and retrograde ejaculation. We report our initial experience with transurethral intra- prostatic injection of dehydrated alcohol as the only treat- ment modality for obstructive hyperplasia of the prostate. To date 24 patients have been treated under our New Jersey Medical School protocol. Of the first 15 patients 13 have now been followed more than 1 year postoperatively. MATERIALS AND METHODS A total of 15 patients with documented outlet obstruction secondary to BPH in a prostate estimated to be 22 to 75 gm. were enrolled in the study. These patients had a mean peak urine flow rate preoperatively of 5.7 cc per second and the average American Urological Association (AUA) symptom score was 22.4 (figs. 1 and 2). Prostates suspected of harboring cancer were excluded from study. All patients with prostate specific antigen (PSA) greater than 4 ng./ml. underwent transrectal ultrasound guided prostate biopsy to exclude clinically significant can- cer. A drawback of this procedure is that it does not provide resected tissue suitable for careful histological inspection. No patients in acute urinary retention were included in this study. Candidates were older than 50 years old with signifi- cant symptoms more than 6 months in duration, AUA symp- tom score greater than 8, peak urine flow less than 15 cc per second, post-void residual urine less than 300 cc and prostate volume less than 100 gm. Study exclusion criteria were con- firmed or suspected malignancy, compromised renal func- tion, previous pelvic surgery or trauma, previous invasive treatment for BPH and endoscopic evidence of significantly obstructive adenoma distal to the verumontanum. All patients provided informed consent to undergo this elective procedure in this institutional review board ap- proved study. Carefully placed serial intraprostatic injec- tions of dehydrated ethanol were performed transurethrally using the Injectx endoscopic device. 1 Transrectal ultrasound Accepted for publication November 2, 2001. FIG. 1. Peak urine flow rate improvement FIG. 2. AUA symptom score improvement 0022-5347/02/1675-2100/0 THE JOURNAL OF UROLOGY ® Vol. 167, 2100 –2104, May 2002 Copyright © 2002 by AMERICAN UROLOGICAL ASSOCIATION,INC. ® Printed in U.S.A. 2100