Hydrodissection using 10% dextrose before focal therapy of prostate cancer: Initial experience.

Objectives: To evaluate the feasibility and safety of hydrodissection of the prostato-rectal space using 10% dextrose for focal therapy of posterior prostate tumours. Patients and methods: We included consecutive patients who underwent focal therapy for a posterior prostate tumour with a prior injection of 10% dextrose in the prostato-rectal space, between October 2024 and February 2025. The main outcomes were to evaluate the space created using this technique. As the technique used for hydrodissection was modelled on periprostatic nerve block, we analysed a cohort of patients who underwent transperineal prostate biopsies with periprostatic nerve block using 20 ml of lidocaine, to compare the prostato-rectal spaces created by 10% dextrose and by lidocaine. Results: A total of 11 patients underwent a focal therapy with a prior 20 ml 10% dextrose hydrodissection of the prostato-rectal space. Fifteen patients who underwent prostatic biopsies using a periprostatic nerve block (20 ml of lidocaine), with similar characteristics, were included. The median prostato-rectal space created with dextrose and with lidocaine was 8.9 [8.0; 9.9] and 6.7 [6.4; 8.4] mm, respectively (p = 0,17). The prostato-rectal space decreased slower with dextrose: 0.03 mm/min vs 0.1 mm/min (p = 0,02). The prostato-rectal space was higher at the end of focal therapy procedures (7.9 vs 6.6 mm, p = 0,033), despite a longer procedure time in focal therapy (37 vs 8 min, p < 0,001). At the end of focal therapy procedures, all patients had a prostato-rectal space > 5 mm. No hydrodissection-related adverse event was observed. Conclusions: These initial results suggest that hydrodissection of the prostate-rectal space using 20 ml 10% dextrose, injected following a standard periprostatic nerve block protocol, is feasible, reproducible and safe for a focal therapy procedure for localized posterior prostate tumours.