Cryosurgical Urology

  • Douglas Chinn


One of the earliest roles of urologic cryosurgery was the treatment of BPH. A transurethral approach was utilized with liquid nitrogen. A single closed probe system, using liquid nitrogen, was placed transurethrally. Transrectal digital palpation and/or thermocouple monitoring were used to help monitor the freezing process. Suprapubic cystoscopy was used to monitor the bladder neck. This treatment was usually reserved for patients with very large glands and severe symptoms, but who were not good surgical candidates for conventional procedures (1). For unknown reasons, the focus of modern cryosurgery has since its advent been on malignant tissue. Perhaps this is due in part to the large number of excellent treatment choices available for BPH by the time a multiprobe liquid nitrogen system was developed (2). The extensive clinical experience in treating prostate cancer with cryosurgery has clearly demonstrated the efficacy of this method in decreasing prostate volume as measured by ultrasound in post cryosurgical biopsies.


Prostate Cancer Neurovascular Bundle External Sphincter Benign Prostatic Hypertrophy Rectal Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gonder MJ, Soanes WA, Smith V. Chemical and morphologic changes in the prostate following extreme cooling. Ann. N.Y. Acad. Sci. 1965; 125: 716–729.PubMedCrossRefGoogle Scholar
  2. 2.
    Wong WS, Chinn DO, Chinn M, Chinn J, Tom WL, Tom WL. Cryosurgery as a treatment for prostate carcinoma, results and complications. Cancer 1997; 79: 963–974.PubMedCrossRefGoogle Scholar
  3. 1.
    Ahlering TE, Lieskovsky G, Skinner DG. Salvage surgery plus androgen deprivation for radioresistant adenocarcinoma. J Urol 1992; 147: 900–902.PubMedGoogle Scholar
  4. 2.
    Badalament, R.A., Bahn, D.K., Kim, H., Kumar, A., Bahn, J.M., Lee, F. Patient-reported complications after cryoablation therapy for prostate cancer. Urology 1999; 54 (2): 295–300.PubMedCrossRefGoogle Scholar
  5. 3.
    Bahn, D.K., Lee, F., Solomon, M.H., Gontina, H., Klionsky, D.L., Lee, F.T. Jr., Prostate cancer, US-guided percutaneous cryoablation. Radiology 1994; 190 (2): 551–556.Google Scholar
  6. 4.
    Bischof, J.C., Smith, D., Pazhayannur, P.V., Manivel, C, Hulbert, J., Roberts, K.P. Cryosurgery of dunning AT-1 rat prostate tumor: thermal, biophysical, and viability response at the cellular and tissue level. Cryobiology 1997; 34: 42–69.PubMedCrossRefGoogle Scholar
  7. 5.
    Bonney, W.W., Fallon, B., Gerber, W.L., Hawtrey, C.E., Loening, S.A., Narayana A.S., Platz, C.E., Rose, E.F., Sail, J.C., Schmidt, J.D., Culp, D.A. Cryosurgery in prostatic cancer: survival. Urology 1982; 19: 37–42.PubMedCrossRefGoogle Scholar
  8. 6.
    Brandt, B., Hibon, J. Lemaire, Ph., Domina, D., Lardennois, B. Ultrasonography and cryosurgery of the prostate. Cryotherapy 1985; 7.Google Scholar
  9. 7.
    Brenner, P.C., Russo, P., Wood, D.P. Salvage radical prostatectomy in the management of locally recurrent prostate cancer after 125-I implantation. Br J Urol 1994; 75: 44–47.CrossRefGoogle Scholar
  10. 8.
    Cepedes, R.D., Pister, L.L., von Eschenbach, A.C., McGuire, E.J. Longterm follow-up of incontinence and obstruction after salvage cryosurgical ablation of the prostate: results in 143 patients. J Urol 1997; 157: 237–240.CrossRefGoogle Scholar
  11. 9.
    Chin, J.L., Downey, D.B., Mulligan, M., Fenster, A. Three-dimensional transrectal ultrasound guided cryoablation for localized prostate cancer in nonsurgical candidates: a feasibility study an report of early results. J Urol 1998; 159: 910–914.PubMedCrossRefGoogle Scholar
  12. 10.
    Chinn, D. Prostate cryosurgery: scientific and technical advancements. Urology News 1999; 3 (4): 10–12.Google Scholar
  13. 11.
    Cohen, J.K., Miller, R.J., Rooker, G.M., Shuman, B.A. Cryosurgical ablation of the prostate: Two year prostatic specific antigen and biopsy results. J Urology 1996; 47: 395–401.CrossRefGoogle Scholar
  14. 12.
    Corral, D.A., Pister, L.L., von Eschenbach, A.C. Treatment options for localized recurrence of prostate cancer following radiation therapy. Urol Clin North Am 1996; 23: 677–684.PubMedCrossRefGoogle Scholar
  15. 13.
    De La Taille, A., Hayek, O., Benson, M.C., Bagiella, E., Olsson, C.A., Katz, A.E. Salvage therapy for recurrent prostate cancer after radiation therapy: the Columbia experience. Urology 2000; 55 (1): 79–84.PubMedCrossRefGoogle Scholar
  16. 14.
    De La Taille, A., Benson, M.C., Bagiella, E., Burchardt, M., Shabsigh, A., Olsson, C.A., Katz, A.E. Cryoablation for clinically localized prostate cancer using an argon-based system: complication rates and biochemical recurrence. BJU International 2000; 85: 281–286.CrossRefGoogle Scholar
  17. 15.
    Farrant, J., and Walter, C.A. The cryobiological basis for cryosurgery. J Dermatol Surg Oncol 1977; 3: 403–407.PubMedGoogle Scholar
  18. 16.
    Flocks, R.H., Nelson, C.K., Boatman, D.L. Perineal cryosurgery for prostatic carcinoma. J Urol 1972; 108: 933–935.PubMedGoogle Scholar
  19. 17.
    Fowler, F.J., Barry M.J., Lu-Yao, Roman, A., Wasser, J., Wennberg, J.E. Patient-reported complications and follow-up treatment after radical prostatectomy. The national Medicare experience 1988-1990 (updated June 1993). Urology 1993; 42: 622–629.PubMedCrossRefGoogle Scholar
  20. 18.
    Gondor, M.J., Soanes, W.A., Shulman, S. Cryosurgical treatment of the prostate. Investig Urol 1966; 3: 372–375.Google Scholar
  21. 19.
    Grampsas, S.A., Miller, G.J., Crawford, E.D. Salvage radical prostatectomy after failed transperineal cryotherapy: histologic findings from prostate whole-mount specimens correlated with intraoperative transrectal ultrasound images. Urology 1995; 45 (6): 936–941.PubMedCrossRefGoogle Scholar
  22. 20.
    Gursel, E., Roberts, M., Veenema, R.J. Regression of prostatic cancer following sequential cryotherapy to the prostate. J Urol 1972; 108: 928–932.PubMedGoogle Scholar
  23. 21.
    Jønler, M., Ritter, M.A., Brinkman, R., Messing, E.M., Rhodes, P.R., Bruskewi, R.C. Sequelae of definitive radiation therapy for prostate cancer localized to the pelvis. Urology 1994; 44: 876–882.PubMedCrossRefGoogle Scholar
  24. 22.
    Jordan W.P., Walker D., Miller Jr., G.H., Drylie D.M. Cryotherapy of benign and neoplastic tumors of the prostate. Surg Gyn & Ob, 1967; 1265–1268.Google Scholar
  25. 23.
    Koppie, T.M., Shinohara, K., Grossfield, G.D., Presti Jr., J.C., Carroll, P.R. The efficacy of cryosurgical ablation of prostate cancer: The University of California, San Francisco experience. J Urol 1999; 162: 427–132.PubMedCrossRefGoogle Scholar
  26. 24.
    Larson, T.R., Robertson, D.W., Corica, A., Bostwick, D.G. In vivo interstitial temperature mapping of the human prostate during cryosurgery with correlation to histopathologic outcomes. Urology 2000; 55 (4): 547–552.PubMedCrossRefGoogle Scholar
  27. 25.
    Lee, F., Bahn, D.K., McHugh, T.A., Onik, G.M., Lee, Jr., F.T. How I do it. US-guided percutaneous cryoablation. How I do it. US-guided percutaneous cryoablationRadiology 1994; 192: 769–776.Google Scholar
  28. 26.
    Lee, F., Bahn, D.K., McHugh, T.A., Kumar, A.A., Badalament, R.A. Cryosurgery of prostate cancer: use of adjuvant hormonal therapy and temperature monitoring-a one year follow-up. Anticancer Res 1997; 17: 1511–1516.PubMedGoogle Scholar
  29. 27.
    Lee, F., Bahn, D., Badalament, R., Kumar, A., Klionsky, D., Onik, G., Chinn, D., Greene, C. Cryosurgery for prostate cancer: improved glandular ablation by use of 6-8 cryoprobes. Urology 1999; 54 (1): 135–140.PubMedCrossRefGoogle Scholar
  30. 28.
    Lerner, S.E., Blute, M.L., Zincke, H. Critical evaluation of salvage surgery for radio-recurrent/resistant prostate cancer. J Urol 1995; 154: 1103–1109.PubMedCrossRefGoogle Scholar
  31. 29.
    Link, P., Freiha, F.S. Radical prostatectomy after definitive radiation therapy for prostate cancer. Urology 1991; 37: 189–192.PubMedCrossRefGoogle Scholar
  32. 30.
    Loening, S., Lubraoff, D. Cryosurgery and immunotherapy for prostatic cancer. Urol Clin North Am 1984; 11: 327–336.PubMedGoogle Scholar
  33. 31.
    Long, J.P., Fallick, J.L., LaRock, D.R., Rand, W. Preliminary outcomes following cryosurgical ablation of the prostate in patients with clinically localized prostate carcinoma. J Urol 1998; 159: 477–484.PubMedCrossRefGoogle Scholar
  34. 32.
    Mazur P. Causes of injury in frozen and thawed cells. Fed Proc 1965; 24 (2) part 3: S175–182.PubMedGoogle Scholar
  35. 33.
    Mazur, P. The role of intracellular freezing in the death of cells cooled at supraoptimal rates. Cryobiology, 1977; 14: 251–272.PubMedCrossRefGoogle Scholar
  36. 34.
    McGrath, J.J., Cravalho, E.G. An experimental comparison of intracellular ice formation and freeze-thaw survival of Hela S-3 Cells. Cryobiology 1975; 12: 540–550.PubMedCrossRefGoogle Scholar
  37. 35.
    Meryman, H. Mechanics of freezing in living cells and tissues. Science 1956; 124 (3221): 515–521.PubMedCrossRefGoogle Scholar
  38. 36.
    Miller, Jr., R.J., Cohen, J.K., Shuman, B., Merlotti, L.A. Percutaneous, transperineal cryosurgery of the prostate as salvage therapy for post radiation recurrence of adenocarcinoma. Cancer 1996; 77: 1510–1514.PubMedCrossRefGoogle Scholar
  39. 37.
    Moul, J.W., Paulson, D.F. The role of radical surgery in the management of radiation recurrent and large volume prostate cancer. Cancer 1991; 68: 1265–1271.PubMedCrossRefGoogle Scholar
  40. 38.
    Neel III, H.B., Ketcham, A.S. Requisites for successful cryogenic surgery of cancer. Arch Surg 1971; 102: 45–48.PubMedCrossRefGoogle Scholar
  41. 39.
    Neerhut, G.J., Wheeler, T., Cantini, M., Scardino, P.T. salvage radical prostatectomy for radiorecurent adenocarcinoma of the prostate. J Urol 1988; 140: 544–548.PubMedGoogle Scholar
  42. 40.
    Onik, G., Cobb, C., Cohen, J., Reyes, G.D., Rubinsky, B., Chang, Z., Baust, J. Transrectal ultrasound-guided percutaneous radical cryosurgical ablation of the prostate. Cancer 1993; 72 (4): 1291–1298.PubMedCrossRefGoogle Scholar
  43. 41.
    Patel, B.G., Parson, C.L., Bidair, J., Schmidt, J.D. Cryoablation for carcinoma of the prostate. J Surg Oncol 1996; 63: 256–264.PubMedCrossRefGoogle Scholar
  44. 42.
    Petersen, D.S., Milleman, L.A., Rose, R.F., Bonney, W.W., Schmidt, J.D., Hawtrey, C.E., Culp, D.A. Biopsy and clinical course after cryosurgery for prostatic cancer. J Urol 1978; 120: 308–311.PubMedGoogle Scholar
  45. 43.
    Pisters, L.L., von Eschenbach, A.C., Scott, S.M., Swanson, D.C., Dinnery, C.P., Pettaway, C.R., Babaian, R.J. The efficacy and complications of salvage cryotherapy of the prostate. J Urol 1997; 157: 921–925PubMedCrossRefGoogle Scholar
  46. 44.
    Pontes, J.E., Montie, J., Klein, E., Huben, R. Salvage surgery for radiation failure in prostate cancer. Cancer 1993; 71: 976–980.PubMedCrossRefGoogle Scholar
  47. 45.
    Rewcastle JC, Sandison GA, Saliken JC, Donnelly BJ, McKinnon JG. Considerations during clinical operation of two commercially available cryomachines. J Surg Oncol 1999 Jun; 71(2): 106–11.PubMedCrossRefGoogle Scholar
  48. 46.
    Rogers, E., Ohori, M., Kassabian, V.S., Wheeler, T.M., Scardino, P. Salvage radical prostatectomy: outcome measured serum prostate specific antigen levels. J Urol 1995; 153: 104–110.PubMedCrossRefGoogle Scholar
  49. 47.
    Shinohara, K., Connolly, J.A., Presti, Jr., J.C., Carroll, P.R. Cryosurgical treatment of localized prostate cancer (Stages T1 to T4): preliminary results. J Urol 1996; 156: 115–121.PubMedCrossRefGoogle Scholar
  50. 48.
    Shuman, B.A., Cohen, J.K., Miller, Jr., R.J. Rooker, C.M., Olson, P.R. Histological presence of viable prostatic glands on routine biopsy following cryosurgical ablation of the prostate. J Urol 1997; 157: 552–555.PubMedCrossRefGoogle Scholar
  51. 49.
    Stein, A., Smith, R.B., deKernion, J.B. Salvage radical prostatectomy after failure of curative radiotherapy for adenocarcinoma of the prostate. Urology 1992; 40: 197–200.PubMedCrossRefGoogle Scholar
  52. 50.
    Tatsutani, K., Rubinsky, B., Onik, G., Dahiya, R. Effect of thermal variables on frozen human primary prostatic adenocarcinoma cells. Urology, 1996; 48: 441–447.PubMedCrossRefGoogle Scholar
  53. 51.
    Wake, R.W., Hollabaugh Jr., R.S., Bond, K.H. Cryosurgical ablation of the prostate for localized adenocarcinoma: a preliminary experience. 1996; 55: 1663–1666.Google Scholar
  54. 52.
    Weider, J., Schmidt, J.D., Casola, G., van Sonnenberg, E., Stainken, B.F., Parson, C.L. Transrectal ultrasound-guided transperineal cryoablation in the treatment of prostate carcinoma: preliminary results. J Urol 1995; 154: 435–441.CrossRefGoogle Scholar
  55. 53.
    Whittaker, D.K. Ice crystals formed in tissue during cryosurgery, I. Light microscopy. Cryobiology 1974; 11: 192–201.PubMedCrossRefGoogle Scholar
  56. 54.
    Whittaker, D.K. Ice crystals formed in tissue during cryosurgery, II. Electron microscopy. Cryobiology 1974; 11: 202–217.PubMedCrossRefGoogle Scholar
  57. 55.
    Widmark, A., Fransson, P., Tavelin, B. Self-assessment questionnaire for evaluating urinary and intestinal late side effects after pelvic radiotherapy in patients with prostate cancer compared with a matched control population. Cancer 1994; 74 (9): 2520–2532.PubMedCrossRefGoogle Scholar
  58. 56.
    Wong, W.S., Chinn, D.O., Chinn, M., Chinn J., Tom W.L., Tom W.L. Cryosurgery as a treatment for prostate carcinoma, results and complications. Cancer 1997; 79: 963–974.PubMedCrossRefGoogle Scholar
  59. 57.
    Yamada, S., Tsubouchi, S. Rapid cell death and cell population recovery in mouse skin epidermis after freezing. Cryobiology 1976; 13: 317–327.PubMedCrossRefGoogle Scholar
  60. 58.
    Zincke, H. Radical prostatectomy and exenterative procedures for local failure after radiotherapy with curative intent: comparison of outcomes. J Urol 1992; 147: 894–899.PubMedGoogle Scholar

Suggested Reading: Ultrasound Physics

  1. 1.
    Chivers R.C., Parry, R.J. Ultrasonic velocity and attenuation in mammalian tissues. J Acoust Soc Am 1978; 63: 940–953.PubMedCrossRefGoogle Scholar
  2. 2.
    Christensen, E.E., Curry, T.S., Dowdey, J.E. Ultrasound. In: An introduction to the physics of diagnostic radiology, 2nd edition. Lea & Febiger, Philadelphia, 1978; pp. 361–394.Google Scholar
  3. 3.
    Goss, S.A., Johnston, R.L., Dunn, F. Comprehensive compilation of empirical properties of mammalian tissues. J Acoust Soc Am 1978; 64: 423–457.PubMedCrossRefGoogle Scholar
  4. 4.
    Kremkau, F.W., Allen. A. Diagnostic Ultrasound: Principles and Instruments. W B Saunders Co, Philadelphia. 1998Google Scholar
  5. 5.
    Merritt CRB: Physics of Ultrasound. In: Rumack, CM., Wilson, S.R., Charboneau, J.W. eds. Diagnostic Ultrasound. Mosby, New York, 1998; pp..2–23.Google Scholar
  6. 6.
    Merritt, C.R.B. Doppler US: The basics. Radiographics, 1991; 11:109–119.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2001

Authors and Affiliations

  • Douglas Chinn

There are no affiliations available

Personalised recommendations