Handbook of Urologic Cryoablation PDF

Preface

Humankind, from the early Neanderthals to the passengers and crew of the Titanic, has long understood one fact; cold temperatures kill. However, it wasn't until the 1950s that the lethal power of cold could be harnessed and directed against specific human diseases such as cancer. Initially, liquid nitrogen was pumped through metal needles that had been placed under visual guidance into a specific disease site. The early cryosurgeon then used visual cues and an intrinsic understanding of threedimensional anatomy to control the extent of the cold-induced injury. Predictably, the targeted tissue was indeed killed. However, the adjacent, and often vital, structures were also injured with many adverse outcomes.

Technical improvements in the delivery of cold-inducing cryogens such as liquid nitrogen and high-pressure argon gas in the 1990s rejuvenated the in situ ablative treatment approach. The final tipping point was reached when body imaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance (MRI) were used to directly monitor the location and extent of the ablation zone. The ice created by the cryo-units was found to be hyperechoic on ultrasound and easily visible on both CT and MRI. Finally, the concept of image-guided tissue ablation was successfully extended beyond the boundaries of radiation therapy. Currently, individuals who find themselves in the complex circumstance of harboring a cancer within an organ or tissue that is closely approximated to other vital structures can choose from an array of ablative techniques that can be individualized to their specific illness.

The development of special equipment for the thermal destruction, with both cold injury and heat induced tissue necrosis, of neoplastic lesions within the adrenal gland, kidney and prostate has contributed to the recent establishment of the new medical specialty of interventional oncology. The wide availability of the required equipment has allowed individual medical practitioners from urology, surgical oncology, thoracic surgery and interventional radiology to treat cancers that were previously only treated with surgical excision or radiation therapy. These new treatment options hold much promise for the effective treatment of early cancers while reducing the treatment-related side effects associated with more traditional modalities. However, these new treatment approaches also serve to break down the wellestablished distinctions between medical specialties, which can result in confusion, and tension between those specialties. Until the various physicians can develop new systems of communication that deliver medical care as a team-based treatment unit, patients may find themselves receiving conflicting opinions about the optimal therapy for their specific problem. Finally, the usual method through which physicians evaluate new treatment strategies over time is being taxed by the rapid identification of ever more effective inventions for tissue ablation. Concomitantly, payment mechanisms must be continually adjusted such that men and women with cancer can receive the benefit of these attractive new modalities.

This "Handbook of Urologic Cryoablation" has been developed to present the current best evidence in the field of tissue ablation and interventional oncology as it applies to the field of urologic oncology. The authors who have contributed chapters for this book are experienced with the engineering of the specific equipment, its history of development and the rationale for its application in the treatment of urologic disease.

Additionally, information has been provided regarding the economics of an ablation program such that interested readers can establish a clinical program that will enable them to readily apply this new knowledge to their patients.