Introduction

To assess whether prior interventional treatment for benign prostatic hyperplasia (BPH) increases the risk of complications of primary whole gland prostate cryoablation.

Methods

Among 3955 men who underwent primary whole gland prostate cryoablation, we identified 156 who had undergone prior therapy for BPH including transurethral needle ablation (n=6), transurethral microwave thermotherapy (n=11), and transurethral resection of the prostate (n = 139). Patients with a history of medical or unspecified BPH therapy were excluded from the study. Primary outcomes included post-treatment urinary incontinence, urinary retention, erectile dysfunction (ED), and recto-urethral fistulae.

Results

Median age was 71 years (IQR 66-76), median Gleason sum 6 (IQR6-7) and median PSA 6.6 ng/mL (IQR 4.8-9.8). Men who received prior BPH therapy were older with median age (74 vs 71, p<0.001), were more likely to have pretreatment Gleason sum ≥7 disease (50% vs 41.5%, p=0.04) and have undergone neoadjuvant androgen deprivation therapy (50% vs.36%, p<0.001). In unadjusted analyses, prior interventional BPH therapy was associated with higher risks of post-operative urinary retention 22 of 149 (14.8%) vs. 325 of 3560 (9.1%), p=0.02 and new-onset urinary incontinence 20 of 144(13.9%) vs. 251/3371 (7.5%), p=0.005 compared to no prior therapy. Interventional BPH therapy was not correlated with the risk of development of recto-urethral fistula 2 of 149 (1.3%) vs. 46 of 3560 (1.3%), p=0.9 or new onset ED 23 of 34 (67.7%) vs. 631 of 1195 (52.8%), p=0.09 following surgery. On multivariable regression, prior interventional BPH therapy was associated with an 83% increased risk of urinary retention (OR 1.83, 95% CI 1.02-3.09, p=0.03) and a 73% increased risk of new-onset urinary incontinence (OR 1.73, 95% CI 1.03-2.78, p=0.03) (Table 1). _x000D_

Conclusions

Prior interventional therapy for BPH is associated with increased risks of urinary retention and incontinence after whole gland prostate cryoablation. Nevertheless, in properly selected patients, prior bladder outlet procedures are not an absolute contraindication to cryotherapy. Consideration should be given to management protocol in those men including but not limited to time for catheter removal postoperatively and continuing BPH medical treatment

Funding

None