Saline injection into Denonvillier's fascia during prostate cryosurgery

The proximity of the rectum to the prostatic capsule has major implications for the safe and effective use of prostate cryosurgery. Freezing of the rectum results in urethro-rectal fistula formation and the fear of rectal freezing can result in the stopping of freezing too early, with cancer recurrence as the result. We describe a simple procedure for increasing the space between the rectum and the prostate (injecting saline into Denonvillier's fascia) thereby increasing the safety and efficacy of prostate cryosurgery. The 61 cases presented demonstrate that the procedure was easily performed in ail but one case, with no incidence of rectal injury occurring. With up to 3 years follow-up, post-procedure median prostate-specific antigen (PSA) for the group was 0.1 ng mL(-1) and the mean PSA was 0.2. We conclude that saline injection into Denonvillier's fascia is easily performed, reducing the risk of rectal injury.