Ethanol injection of prostate

Ethanol injection for chemoablation of the prostate for the treatment of benign prostatic hyperplasia is a concept first described in the early 1900s and one that garnered considerable excitement in the last 15 years. Dehydrated ethanol delivered via transperineal, transurethral, or transrectal approaches can have severe pathologic effects on prostate tissue and serves to atrophy the gland. However, injections result in highly uneven lesions and extraprostatic leakage can have devastating consequences. Studies initially showed promising results, but variable outcomes and lack of standard techniques have hindered the widespread adoption of ethanol ablation. Common adverse effects included dysuria, urinary retention, and hematuria, and rare cases of bladder necrosis have been reported. In this chapter, we will review the techniques and evidence for this approach.