Normal saline prevents urethrorectal fistulas after prostate cryoablation: Study

China: In a new study conducted by Ning Wang and colleagues, it was shown that normal saline (NS) injection can be used to increase the anterior perirectal space following cryoablation surgery which might prevent urethrorectal fistulas, especially for individuals with localized prostate cancer (PCa) who had longer biochemical progression-free survival (bPFS) and lower prostate-specific antigen (PSA) nadir levels.

The purpose of this study is to explain the procedure and assess the therapeutic benefit of using normal saline injection to increase the anterior perirectal space in prostate cancer patients undergoing prostate cryoablation. The findings of this study were published in the European Journal of Surgical Oncology.

The study involved patients with PCa who had cryoablation between August 2014 and December 2019. Patients with localized PCa who had cryoablation as their main form of therapy had their prostate-specific antigen nadir and biochemical progression-free survival evaluated.

The key findings of this study were as follows:

1. There were 159 PCa patients altogether.

2. The median (interquartile range) length of the estimated ice ball edge well beyond the prostatic capsule among 147 individuals having the data of anterior perirectal space was 8.3 mm.

3. There were no occurrences of urethrorectal fistula recorded; nevertheless, 25 patients had scrotal edema and 29 patients had urine retention.

4. Within 7 weeks of surgery, all side effects below Clavien-Dindo grade IIIb subsided.

5. Six individuals reported having urinary incontinence. The median follow-up period was 56.5 months for patients with localized PCa.

6. The predicted 5-year bPFS for PCa patients was 82.3% overall, 82.8% for patients with low to intermediate risk, and 82.1% for patients with high risk.

7. The median (IQR) PSA nadir for the 52 patients who underwent sole cryoablation was 0.147 (0.027-0.381) ng/mL.

Reference:

Wang, N., Zhao, D., Chen, D., Wu, Z., Wang, Y., Yang, Z., Zhao, J., Zhou, F., & Li, Y. (2022). Clinical value of normal saline injection for expansion of the anterior perirectal space during prostate cryoablation. In European Journal of Surgical Oncology. Elsevier BV. https://doi.org/10.1016/j.ejso.2022.06.032