Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Study Type - Harm (case series) Level of Evidence 4.
What's known on the subject? and What does the study add? There is limited data available to determine the rate of complications following prostate cryosurgery. This is particularly true when limiting the experience to third generation cryoprobes. Herein we thoroughly report all complications and postoperative events, defined as any deviation from an ideal postoperative course, with extended follow up.
There has been a call in the urological literature for standardized reporting of complications. To use strict criteria aiming to report our complications and other postoperative events in a cohort of men undergoing third-generation prostate cryosurgery.
Demographic, clinical and pathological data were collected on men undergoing primary cryosurgery from 2002-2010, excluding those who had received neoadjuvant or adjuvant radiotherapy. Complications and events were broadly defined as any deviation from the expected postoperative course and any subjective complaint expressed during a follow-up visit. Descriptive statistics were generated and compared between groups using chi-squared and rank sum tests as appropriate. Logistic regression analyses were performed to assess the potential predictors of any complication or event.
In total, 106 consecutive patients were identified. There were no intra-operative complications or instances of equipment failure. We observed 42 early complications, with 48 delayed and 10 late postoperative events. A total of five (4.7%) patients had persistent urge and/or stress incontinence. Thirty-one patients had International Prostate Symptom Score (IPSS) and bother index scores available before and after surgery; median scores decreased from 7 and 2 to 6 and 1, for IPSS and bother index, respectively. Twenty-four patients had Sexual Health Inventory for Men scores available before surgery and at 2-year follow-up; median scores decreased from 11 to 2. On multivariate analysis, there were no significant associations.
Modern cryosurgery is safe, and most of the complications and postoperative events are transient. Erectile function, however, has marked deterioration. We were unable to identify significant risk factors for complications or postoperative events.
Caso JR, Tsivian M, Mouraviev V, Kimura M, Polascik TJ. Are you the author?
Reference: BJU Int. 2011 Aug 22. Epub ahead of print.