An investigation of the effects from a urethral warming system on temperature distributions during cryoablation treatment of the prostate: A phantom study

C. P. Favazza, K. R. Gorny, D. M. King, P. J. Rossman, J. P. Felmlee, David A Woodrum, L. A. Mynderse

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction of urethral warmers to aid cryosurgery in the prostate has significantly reduced the incidence of urethral sloughing; however, the incidence rate still remains as high as 15%. Furthermore, urethral warmers have been associated with an increase of cancer recurrence rates. Here, we report results from our phantom-based investigation to determine the impact of a urethral warmer on temperature distributions around cryoneedles during cryosurgery. Cryoablation treatments were simulated in a tissue mimicking phantom containing a urethral warming catheter. Four different configurations of cryoneedles relative to urethral warming catheter were investigated. For each configuration, the freeze-thaw cycles were repeated with and without the urethral warming system activated. Temperature histories were recorded at various pre-arranged positions relative to the cryoneedles and urethral warming catheter. In all configurations, the urethral warming system was effective at maintaining sub-lethal temperatures at the simulated surface of the urethra. The warmer action, however, was additionally demonstrated to potentially negatively impact treatment lethality in the target zone by elevating minimal temperatures to sub-lethal levels. In all needle configurations, rates of freezing and thawing were not significantly affected by the use of the urethral warmer. The results indicate that the urethral warming system can protect urethral tissue during cryoablation therapy with cryoneedles placed as close as 5. mm to the surface of the urethra. Using a urethral warming system and placing multiple cryoneedles within 1. cm of each other delivers lethal cooling at least 5. mm from the urethral surface while sparing urethral tissue.

Original languageEnglish (US)
Pages (from-to)128-133
Number of pages6
JournalCryobiology
Volume69
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Cryosurgery
Catheters
Urinary Catheters
Prostate
Temperature distribution
catheters
Tissue
cryosurgery
urethra
Temperature
Urethra
temperature
Thawing
Freezing
Needles
freeze-thaw cycles
Incidence
angle of incidence
thawing
Cooling

Keywords

  • Cryoablation
  • Cryoneedle
  • Cryotherapy
  • Phantom experiment
  • Prostate
  • Prostate cancer
  • Urethral warmer

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

An investigation of the effects from a urethral warming system on temperature distributions during cryoablation treatment of the prostate : A phantom study. / Favazza, C. P.; Gorny, K. R.; King, D. M.; Rossman, P. J.; Felmlee, J. P.; Woodrum, David A; Mynderse, L. A.

In: Cryobiology, Vol. 69, No. 1, 2014, p. 128-133.

Research output: Contribution to journalArticle

Favazza, C. P. ; Gorny, K. R. ; King, D. M. ; Rossman, P. J. ; Felmlee, J. P. ; Woodrum, David A ; Mynderse, L. A. / An investigation of the effects from a urethral warming system on temperature distributions during cryoablation treatment of the prostate : A phantom study. In: Cryobiology. 2014 ; Vol. 69, No. 1. pp. 128-133.
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abstract = "Introduction of urethral warmers to aid cryosurgery in the prostate has significantly reduced the incidence of urethral sloughing; however, the incidence rate still remains as high as 15{\%}. Furthermore, urethral warmers have been associated with an increase of cancer recurrence rates. Here, we report results from our phantom-based investigation to determine the impact of a urethral warmer on temperature distributions around cryoneedles during cryosurgery. Cryoablation treatments were simulated in a tissue mimicking phantom containing a urethral warming catheter. Four different configurations of cryoneedles relative to urethral warming catheter were investigated. For each configuration, the freeze-thaw cycles were repeated with and without the urethral warming system activated. Temperature histories were recorded at various pre-arranged positions relative to the cryoneedles and urethral warming catheter. In all configurations, the urethral warming system was effective at maintaining sub-lethal temperatures at the simulated surface of the urethra. The warmer action, however, was additionally demonstrated to potentially negatively impact treatment lethality in the target zone by elevating minimal temperatures to sub-lethal levels. In all needle configurations, rates of freezing and thawing were not significantly affected by the use of the urethral warmer. The results indicate that the urethral warming system can protect urethral tissue during cryoablation therapy with cryoneedles placed as close as 5. mm to the surface of the urethra. Using a urethral warming system and placing multiple cryoneedles within 1. cm of each other delivers lethal cooling at least 5. mm from the urethral surface while sparing urethral tissue.",
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AB - Introduction of urethral warmers to aid cryosurgery in the prostate has significantly reduced the incidence of urethral sloughing; however, the incidence rate still remains as high as 15%. Furthermore, urethral warmers have been associated with an increase of cancer recurrence rates. Here, we report results from our phantom-based investigation to determine the impact of a urethral warmer on temperature distributions around cryoneedles during cryosurgery. Cryoablation treatments were simulated in a tissue mimicking phantom containing a urethral warming catheter. Four different configurations of cryoneedles relative to urethral warming catheter were investigated. For each configuration, the freeze-thaw cycles were repeated with and without the urethral warming system activated. Temperature histories were recorded at various pre-arranged positions relative to the cryoneedles and urethral warming catheter. In all configurations, the urethral warming system was effective at maintaining sub-lethal temperatures at the simulated surface of the urethra. The warmer action, however, was additionally demonstrated to potentially negatively impact treatment lethality in the target zone by elevating minimal temperatures to sub-lethal levels. In all needle configurations, rates of freezing and thawing were not significantly affected by the use of the urethral warmer. The results indicate that the urethral warming system can protect urethral tissue during cryoablation therapy with cryoneedles placed as close as 5. mm to the surface of the urethra. Using a urethral warming system and placing multiple cryoneedles within 1. cm of each other delivers lethal cooling at least 5. mm from the urethral surface while sparing urethral tissue.

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