Cryosurgery

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Cryosurgery, first performed on humans in the mid-1960s, was largely abandoned until recently due to a high complication rate. Recently, there has been a trend toward implementing minimally invasive techniques to treat prostate cancer. Cryo-surgery is one of these minimally invasive procedures, and is defined as the in situ reduction of tumor by the application of subzero temperatures.95

Potency after cryosurgery has been poor. Rates of erectile dysfunction after this procedure have ranged from 100% to 10% depending on the length of follow-up.91'95-99 Immediately after cryosurgery, impotence is almost universal as the neurovascular bundles thaw. As time progresses after surgery, there is evidence that erectile function returns in some patients. Bahn et al. reported impotence rates of 90% after 6 months, but only 41% after 1 year.100 Other studies confirmed that the impotence is usually transient with 86% of patients recovering erectile function to some degree.95'97'99 Immediate postoperative impotence is caused by the iceball extending into the lateral periprostatic tissue, which shelters the neurovascular bundles.98 The neurovascular bundles are, therefore, destroyed by the extreme cold temperature. In addition, patients have noted decreased sensitivity and parasthesia of the glans penis and general penile numbness 3 months after cryosurgery.91,98 This may be secondary to damage to the pudendal nerve during the freezing process. These parasthesias over the penis may point to a neurogenic cause of erectile dysfunction after cryosurgery. However, a decreased peak velocity of blood flow within the cavernosal arteries was discovered after cryosurgery in another study - implying a vascular cause.101

Cryosurgery has the potential to become a low-morbidity treatment option for elderly men with organ-confined disease or local recurrence after radiotherapy. Patients should not be told that cryosurgery has decreased rates of impotence as compared to radical prostatectomy and external beam radiation, and that long-term results are unknown. Erectile function improves with time after cryosurgery and patients may benefit from sildenafil.

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