Transurethral ethanol injection into the prostate (TUEIP) is an effective treatment for persistent urinary retention resulting from prostatic obstruction, according to a Japanese study.
Kazuaki Mutaguchi, MD, of the NakatsuDaiichiHospital in Nakatsu, and his colleagues studied the use of TUEIP in 21 Japanese men with persistent urinary retention secondary to benign prostatic hyperplasia or advanced prostate cancer. The men had a median age of 84 years and a mean preoperative prostate volume of 57.6 cm3. Under sacral or lumbar anesthesia, 6-14 mL of dehydrated ethanol was injected into the prostate under endoscopic guidance followed by placement of an indwelling catheter.
Of the 16 patients with BPH and five with advanced prostate cancer, 14 (87.5%) and 3 (60%), respectively, were able to void spontaneously after catheter removal. No additional treatment was needed during the 2-24 months (mean 16 months) of follow-up. Six months postoperatively, the residual urine volume of these 17 patients was 20-150 mL (mean 60 mL) and their mean prostate volume had decreased from 52.7 to 37.9 cm3 (a 28.1% decline). No major complications were observed.
“TUEIP may be an alternative to transurethral resection of the prostate for high-risk or elderly patients who cannot tolerate surgery,” the authors concluded.
The researchers noted that the dehydrated ethanol they used is a chemical agent that already has been used widely for various lesions, such as thyroid adenoma and hepatocellular carcinoma. In addition, ethanol injection has been used for therapeutic embolization of the kidney and ablation of renal cysts. “The primary mechanism of its action is assumed to be chemical ablation,” they wrote. “When injected in human tissues, it produces hemorrhagic coagulation necrosis and thrombotic closure of local arterioles and venules, thereby excising necrotic areas from the tissues.”