Continuous Retroflexion Cystoscopy During Prostate Cryoablation

Abstract

During cryotherapy of the prostate, identification of probe tips that are misplaced into the bladder is often not readily apparent via transrectal ultrasonography. Ultimately, cystoscopy is needed to ensure this has not occurred before initiating a freeze. We describe the innovative use of continuous flexible cystoscopy in retroflexion for visualization of the bladder neck during insertion and manipulation of cryoprobes. Using this technique, it is possible to identify probes errantly placed into the bladder lumen in real time, thereby facilitating safe and accurate placement and eliminating an unnecessary step in the cryotherapy procedure. Instead of placing a Foley catheter at the beginning of the cryotherapy procedure, a flexible cystoscope is advanced into the bladder lumen and retroflexed at the onset of the procedure. The cystoscope is maintained in this position during cryoprobe placement. This real-time observation of the bladder neck allows for immediate withdrawal and repositioning of cryoprobes inadvertently advanced into the bladder. This technique also obviates the need for Foley catheter placement at the beginning of the procedure and subsequent removal after cryoprobe insertion to allow for cystoscopic evaluation for inadvertent cryoprobe insertion into the bladder or urethral lumen.