Cryoablation for benign prostatic hyperplasia is a minimally invasive treatment that destroys excess prostate tissue using extreme cold. This method reduces urinary symptoms caused by prostate enlargement.
The procedure is performed under imaging guidance, where special probes deliver freezing temperatures to targeted areas, sparing surrounding healthy tissue.
Cryoablation provides symptom relief, improves urinary flow, and decreases the risk of complications compared to traditional surgery. It is especially beneficial for patients who cannot undergo major operations.
This technique offers shorter recovery, fewer side effects, and high treatment success rates, making it an effective option in managing benign prostatic hyperplasia.
How Is Cryoablation Performed for BPH?
Cryoablation stands out as a minimally invasive option in BPH treatment. The procedure begins with a detailed preoperative evaluation and planning. Techniques such as transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI) are used to determine the prostate’s size, shape, and location—critical for accurate placement of the cryoprobes.
The surgery is usually performed under general or spinal anesthesia, with the patient placed in the lithotomy position to facilitate access to the perineal area. Under real-time imaging guidance, thin, needle-like cryoprobes are inserted transperineally into the prostate. The number and arrangement of probes are carefully planned to fully cover the target area.
During the procedure, argon gas is used to rapidly cool the probe tips to between –40 °C and –196 °C, forming ice balls at the tips. The freezing process typically consists of two cycles. In the first cycle, cell membranes are damaged, then helium gas is used to thaw the tissue. The second freeze–thaw cycle increases cytotoxic effects, ensuring complete ablation of the target tissue.
Throughout the procedure, safety measures such as urethral warming catheters are used to prevent collateral thermal injury. Temperatures are monitored in real time. After the procedure, patients are observed for a short period; a urinary catheter may be required, and discharge timing depends on individual recovery. Follow-up appointments assess treatment outcomes and monitor for potential complications.
What Are the Potential Benefits of Cryoablation for BPH Patients?
Cryoablation emerges as a less invasive alternative compared to traditional surgical methods in BPH treatment. By using extreme cold to target prostate tissue, its minimally invasive nature can accelerate patient recovery. Compared to conventional surgeries, it offers shorter operation times and reduced hospital stays, enabling patients to return to normal daily activities more quickly.
Cryoablation provides an alternative solution particularly for patients who do not respond to other treatments or have high surgical risks. Low bleeding risk and reduced need for blood transfusions are significant advantages, benefiting patients with bleeding tendencies or fragile health conditions.
Improving urinary function is a primary goal in BPH therapy. As with other minimally invasive techniques, cryoablation can help alleviate symptoms. Although data specific to BPH remain limited, studies have reported significant improvements in International Prostate Symptom Scores (IPSS).
Additionally, this method may support preservation of urinary continence and can be safely applied in patients with persistent symptoms despite previous treatments. These characteristics make cryoablation a promising option in BPH management.
What Are the Risks and Complications Associated with Cryoablation for BPH?
While cryoablation represents an innovative approach in BPH treatment, several risks and complications may arise post-procedure. The frequency and severity of these complications depend on factors such as patient age, overall health, procedural technicalities, and the operator’s experience.
Erectile dysfunction (ED) is one of the most common complications following cryoablation. Reported ED rates vary from 47% to 100% in different studies, closely related to pre-procedure erectile status and individual factors. Urinary incontinence, either stress or urge type, may occur—often limited to mild leakage but occasionally causing significant issues in some patients.
Urinary retention is another common problem after the procedure; although often temporary, it may require additional interventions. Urinary tract infections and, rarely, prostatitis have also been reported. Bleeding and hematuria (blood in the urine) are generally mild but can rarely lead to serious complications.
A rare but serious risk is rectourethral fistula, which requires surgical intervention. Urethral strictures and post-procedure pain may also vary among patients. Early detection and careful follow-up are critical in managing these complications.
Who Are Ideal Candidates for Cryoablation in BPH Treatment?
Cryoablation is an attractive alternative for BPH patients seeking options beyond traditional methods. However, this treatment is not suitable for every patient, and candidate selection requires thorough evaluation. Patients who do not respond to standard medical therapies (alpha-blockers or 5-alpha-reductase inhibitors) or cannot tolerate these medications may be suitable candidates. It also offers a minimally invasive option for individuals who are not candidates for surgical interventions like transurethral resection of the prostate (TURP).
Prostate size and anatomy are important criteria. Cryoablation may be more appropriate for prostates of certain sizes or those not amenable to other minimally invasive techniques. However, exact size criteria are not yet fully defined. Patients with moderate to severe lower urinary tract symptoms (LUTS) that significantly affect quality of life, typically assessed by the International Prostate Symptom Score (IPSS), may be considered candidates.
Before performing cryoablation, it is critical to rule out prostate cancer, usually with PSA testing and, if necessary, biopsy. Patient preference and informed consent are also essential. Patients must be informed about the experimental nature of this treatment and the limited long-term data. Cryoablation should be performed in carefully selected candidates after weighing benefits and risks.
What Is the Current Status and Future Outlook of Cryoablation in BPH Treatment?
BPH is a widespread condition characterized by lower urinary tract symptoms that can severely impact quality of life. In addition to traditional surgical and medical treatments, minimally invasive techniques are gaining attention. Cryoablation is an innovative method aiming to destroy hyperplastic prostate tissue in a controlled manner using extreme cold.
- Current Status: Clinical studies suggest that cryoablation may offer potential benefits in alleviating lower urinary tract symptoms. A 2011 case series demonstrated efficacy in patients unresponsive to other treatments. Compared to radiofrequency and microwave ablation, cryoablation may yield more favorable outcomes, although comparative data specific to BPH remain scarce. It is not yet included as a standard treatment in major urology guidelines and is mostly limited to experimental applications.
- Future Outlook: Research is focusing on developing new cryoablation technologies that enhance target tissue specificity, minimize collateral damage, and optimize technical success. Advances in imaging systems support these efforts. If efficacy is confirmed, cryoablation could become a significant alternative to traditional surgery, offering fewer complications and shorter recovery times. Large-scale studies supporting safety and efficacy may pave the way for regulatory approval and guideline inclusion.
Interventional Radiology and Neuroradiology Speaclist Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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