Probe Placement Process

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Probe Placement Process
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Ultrasound Image of Placed CryoProbes
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Sagittal Probe Placement Sequence
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Step 4Freeze/Thaw Process

• Activate 1st freeze anterior to posterior
• After completion of 1ST freeze cycle, actively
  thaw until prostate visualized by ultrasound
• Check position of all probes
• 2ND freeze cycle
• Final Active or passive thaw

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Freeze Target Temperatures
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Freeze Sequence Anterior to Posterior
CryoProbes in Stick Mode
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Freeze Sequence Anterior to Posterior
Activate Cryoprobes 1 2 Anterior temperature
will drop
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Freeze Sequence Anterior to Posterior
Anterior temperature reaches 0? Activate
Cryoprobes 3 4 NVBs temperature will
drop Monitor Denon Temperature
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Freeze Sequence Anterior to Posterior
NVBs temperature reaches 0? Activate Cryoprobes
5 6 Monitor Denon Temperature
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Freeze Sequence Anterior to Posterior

• Freeze completion Transverse

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Freeze Sequence Anterior to Posterior

• Completion of Freeze Sagittal

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Final Steps

• Active Thaw until all Temps gt 0 degrees
• Remove probes
• Perineal pressure for hemostasis
• Rectal exam confirm no ice in rectum
• Urethral warmer, passive thaw at least 20 min
• Can move warmer to RR
• Foley catheter or S-P tube (your choice)

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Post Op Management

• Same Day Surgery
• Urinary Retention average 10 days, Foley/SP
• Antibiotic 10 days
• Alpha Blocker 30 days
• Pain Management oral narcotic 2-3 days, Urised 2
  weeks, NSAID
• Bowel Management stool softener 2 weeks
• Return to full activity 1 -2 weeks

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Penile Recovery

• Goal simulate normal nocturnal erections until
  nerves recover
• Minimize penile fibrosis and atrophy
• VED daily Two 5 minute cycles without tension
  ring
• Muse 250 ug twice weekly
• PDE5 when spontaneous partial erection returns

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Management of Complications

• Urethral Slough
• Presents as prolonged urinary retention ( gt 30
  days), prolonged dysuria, hematuria, recurrent
  UTI
• Diagnosis office cystoscopy if sx persist gt 6
  weeks
• Initial management Foley catheter, antibiotics,
  pain medication, reassurance
• TURP ideally after 3 months, conservative
  debridement of devitalized tissue

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Management of Complications

• Rectal Fistula
• Rare Event ltlt 1 patient selection, careful
  attention to technique important (probe 5 6)
• Delayed presentation 4-6 weeks, prolonged
  retention, recurrent UTI, liquid stool
• Small Fistula conservative management with
  Foley catheter, antibiotics
• Large Fistula delayed surgical repair, perineal
  approach, muscle flap, fecal diversion

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Its Not Your Grandfathers Cryo Any More