Various embodiments of open system heat exchange catheters and methods of use are disclosed. The various catheters can be used with various ablative surgical devices. One specific exemplary use is in conjunction with cryosurgical probes involving ablation of the prostate, in which the integrity of the urethra is desired to be maintained. Other uses involve various heating ablative devices. In one embodiment an injection tube assembly is used to provide heat exchange fluid through the urethra to the bladder where it is then expelled via a suprapubic suction tube. In other embodiments a coaxial tube assembly is utilized which defines a passageway for either expelling the bladder fluid or for providing access to an endoscope. In other embodiments a double lumen assembly is utilized that defines a passageway for expelling bladder fluid.