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Lo Re M, Polverino P, Rivetti A, Pecoraro A, Saladino M, Pezzoli M, Siena G, De Nunzio C, Li Marzi V, Gacci M, Serni S, Campi R, Sessa F. Transperineal laser ablation (TPLA) of the prostate for benign prostatic obstruction: the first 100 patients cohort of a prospective, single-center study. World J Urol 2024; 42:402. [PMID: 38985193 PMCID: PMC11236842 DOI: 10.1007/s00345-024-05077-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/23/2024] [Indexed: 07/11/2024] Open
Abstract
PURPOSE Transperineal laser ablation (TPLA) is a new minimally-invasive surgical treatment for patients with benign prostatic obstruction (BPO). We report the perioperative and mid-term functional results of the first 100 consecutively patients undergoing TPLA at our institution. METHODS Clinical data from consecutive patients undergoing TPLA at our institution from April 2021 to July 2023 were prospectively collected. Primary endpoints were the postoperative changes in IPSS, QoL and MSHQ 3-item questionnaires and in Qmax and post-void residual volume (PVR). RESULTS Overall, 100 consecutive patients underwent the procedure. Median age and prostate volume were 66 (IQR 60-75) years and 50 (IQR 40-70) ml, respectively. In the cohort, 14 (14%) patients had an indwelling catheter and 81 (81%) were under oral BPO therapy at the time of TPLA. Baseline median Qmax (ml/s) and PVR (ml) were 9.1 (IQR 6.9-12) and 90 (IQR 50-150), respectively, while median IPSS and QoL were 18 (IQR 15-23) and 4 (IQR 3-4). At all the follow-up timepoints, the evaluated outcomes on both symptoms and functional parameters showed a statistically significant improvement (p < 0.001). Antegrade ejaculation was preserved in all sexually active patients. No postoperative Clavien-Dindo > 2 complications were recorded. CONCLUSIONS TPLA represents a safe option for selected well-informed patients swith LUTS due to BPO. Our prospective study confirms the feasibility and favorable perioperative and functional outcomes in a real-world cohort with heterogenous prostate volumes and patient characteristics.
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Affiliation(s)
- Mattia Lo Re
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, 50100, Italy.
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, 50100, Italy.
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Paolo Polverino
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, 50100, Italy
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, 50100, Italy
| | - Anna Rivetti
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, 50100, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, 50100, Italy
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, 50100, Italy
| | - Marco Saladino
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, 50100, Italy
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, 50100, Italy
| | - Marta Pezzoli
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, 50100, Italy
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, 50100, Italy
| | - Giampaolo Siena
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, 50100, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, 50100, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, 50100, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, 50100, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, 50100, Italy
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, 50100, Italy.
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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Wolters M, Krastel M, Winkler T, Idais H, Mazdak M, Tezval H, Kuczyk MA, von Klot CAJ. Real-world experience of water vapour therapy (Rezum) in patients with benign prostatic enlargement: a retrospective single-center study. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00836-w. [PMID: 38658736 DOI: 10.1038/s41391-024-00836-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Water vapor thermal therapy (Rezum) is a minimally invasive treatment for benign prostatic enlargement (BPE). Studies reporting urodynamic results regarding the procedure are rare. Our study aimed to assess the effectiveness of Rezum on urinary outcome parameters in a consecutive series of patients and compare urodynamic data before and after treatment. METHODS We retrospectively evaluated all the patients treated with Rezum between 07/2017 and 12/2023 at our institution. Patients who had more than one Rezum intervention, those who were unable to void (i.e., catheter-dependent patients), and those with insufficient data were excluded from the data analysis. Descriptive outcomes, such as symptom scores (IPSS, IPSS-QoL), peak flow in uroflowmetry (Qmax), post-micturition residual urine volume (PVR), and prostate volume (PVol), were analyzed. If available, preoperative and postoperative urodynamic results were evaluated. RESULTS In total, 250 Rezum procedures were performed during the observational period. After applying the exclusion criteria, the data from 193 patients were included in the analysis. Patients achieved significant symptom relief as measured using the IPSS (46% reduction) and IPSS-QoL scores (41% reduction). Qmax improved by 4.8 ml/s, as the mean PVR significantly decreased by 50%. PVol and PSA values decreased by 30% and 27.5%, respectively. In 19/193 patients with a urodynamic evaluation, pre- and postoperative data analysis showed a significant reduction in the bladder outlet obstruction index (BOOI) by approximately 70%. CONCLUSIONS Rezum is effective and can improve urinary symptoms. In appropriate patients, Rezum can significantly reduce the bladder outlet obstruction (BOO).
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Affiliation(s)
- Mathias Wolters
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - Martin Krastel
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Thorben Winkler
- Department of Urology, DIAKO Hospital Flensburg, Knuthstraße 1, 24939, Flensburg, Germany
| | - Hamza Idais
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Mehrdad Mazdak
- Department of Urology, St. Bernward Hospital Hildesheim, Treibestraße 9, 31134, Hildesheim, Germany
| | - Hossein Tezval
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Markus A Kuczyk
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Christoph-A J von Klot
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625, Hannover, Germany
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Zhu M, Babar M, Hawks-Ladds N, Tawfik MM, Loloi J, Labagnara K, Sayed R, Tang K, Salami A, Singh S, Singh J, Ines M, Iqbal N, Ciatto M. Real-world four-year functional and surgical outcomes of Rezum therapy in younger versus elderly men. Prostate Cancer Prostatic Dis 2024; 27:109-115. [PMID: 37620427 DOI: 10.1038/s41391-023-00703-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Management of urinary symptoms in elderly patients with benign prostatic hyperplasia (BPH) is complex given challenges with medications and invasive surgeries. Rezum, a minimally invasive water vapor therapy, is an emerging alternative. We compare real-world Rezum outcomes between young and elderly patients over 4 years. METHODS We retrospectively analyzed a multiethnic population treated with Rezum at a single center between 2017-2019. Patients were stratified into young (<65 years) or elderly (≥65 years) cohorts. International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), decisional regret scores, and adverse events (AEs) were assessed at baseline, 1-, 3-, 6-, 12-, and/or 48-months. Descriptive statistics were compared using t-tests, Chi-squared, or Mann-Whitney U tests. Changes in outcomes were assessed using Wilcoxon signed-rank tests, stratified by age. RESULTS 256 patients - 146 (57%) young and 110 (43%) elderly - were included. The majority were Asian (33.2%) or non-Hispanic Black (28.9%). Significant improvements were observed in the combined cohort at 4-years in IPSS, QoL, and Qmax when compared to baseline (all p < 0.05). Between the age cohorts, there were no significant differences in IPSS, QoL, or Qmax at any follow-up. Within both cohorts, significant improvements in IPSS and QoL were found from baseline to all follow-ups. In the young cohort, Qmax was significantly improved from baseline to all follow-ups while in the elderly cohort, this was observed only at the 3-month follow-up. No significant differences in AEs or regret was found between cohorts. There was no significant difference in 4-year surgical retreatment rates between cohorts (elderly 4.0% vs young 4.4%, p = 0.86). CONCLUSIONS There were no significant differences in IPSS, QoL, or AEs between elderly and younger men over 4 years following Rezum, suggesting comparable benefits and risks. Future research is warranted to clarify the impact of Rezum on Qmax in elderly men.
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Affiliation(s)
- Michael Zhu
- Albert Einstein College of Medicine, Bronx, NY, USA.
| | | | | | | | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Rahman Sayed
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kevin Tang
- Albert Einstein College of Medicine, Bronx, NY, USA
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Siena G, Sessa F, Cindolo L. Use of a Schelin Catheter for analgesia during Rezum treatment of the prostate. Prostate Cancer Prostatic Dis 2024; 27:147-149. [PMID: 36639547 PMCID: PMC9838278 DOI: 10.1038/s41391-023-00644-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/17/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
To further enhance the minimal invasiveness of Rezum treatment (RT), we sought to evaluate the advantages and feasibility of transurethral intraprostatic anesthesia (TUIA) via Schelin Catheter™ (SC). We enrolled 20 men with LUTS due to BPH, who underwent RT using TUIA via SC. Prior to the procedure, patients were asked to rate their pain on a numeric rating scale (NRS) numbered 0-10: with 0 being "No pain" and 10 being "Worst pain". Median NRS score ranged from 0 to 3. No perioperative procedure-related complications were reported.
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Affiliation(s)
- Giampaolo Siena
- Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi University Hospital, Florence, Italy.
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luca Cindolo
- Department of Urology, Villa Stuart Private Hospital, Rome, Italy
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Cash H, Wendler JJ, Minore A, Goumas IK, Cindolo L. Primary bladder neck obstruction in men-new perspectives in physiopathology. Prostate Cancer Prostatic Dis 2024; 27:54-57. [PMID: 37422524 PMCID: PMC10876476 DOI: 10.1038/s41391-023-00691-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/04/2023] [Accepted: 06/23/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Hannes Cash
- Clinic of Urology, Urooncology, Robotic and Focal Therapy of University Magdeburg, Magdeburg, Germany.
- PROURO, Berlin, Germany.
| | - Johann Jakob Wendler
- Clinic of Urology, Urooncology, Robotic and Focal Therapy of University Magdeburg, Magdeburg, Germany
| | - Antonio Minore
- Department of Urology, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Luca Cindolo
- Department of Urology, Hesperia Hospital, CUrE Group, Modena, Italy
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Nguyen DD, Li T, Ferreira R, Baker Berjaoui M, Nguyen ALV, Chughtai B, Zorn KC, Bhojani N, Elterman D. Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: A review of Aquablation, Rezum, and transperineal laser prostate ablation. Prostate Cancer Prostatic Dis 2024; 27:22-28. [PMID: 37081044 DOI: 10.1038/s41391-023-00669-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is one of the most common diseases affecting men and can present with bothersome lower urinary tract symptoms (LUTS). Historically, transurethral resection of the prostate (TURP) has been considered the gold standard in the treatment of LUTS due to BPH. However, TURP and other traditional options for the surgical management of LUTS secondary to BPH are associated with high rates of sexual dysfunction. In the past decade, several novel technologies, including Aquablation therapy, convective water vapor therapy (Rezum), and transperineal prostate laser ablation (TPLA), have demonstrated promising evidence to be safe and effective while preserving sexual function. METHODS In this review, we discuss three ablative minimally invasive surgeries: Aquablation, Rezum, and TPLA. We review their techniques, safety, as well as perioperative and functional outcomes. We go into further detail regarding sexual function after these ablative minimally invasive surgical therapies. RESULTS Aquablation is a surgeon-guided, robot-executed, heat-free ablative waterjet procedure with sustained functional outcomes at 5 years while having no effect on sexual activity. Rezum is an innovative office-based, minimally invasive surgical option for BPH that delivers convective water vapor energy into prostate adenoma to ablate obstructing tissue. Rezum leads to significant improvements in Qmax, IPSS while preserving sexual function. TPLA is another office-based technology which uses a diode laser source to produce thermoablation. It leads to improvement in Qmax, IPSS, and QoL while preserving ejaculatory function. CONCLUSIONS Overall, ablative minimally invasive surgical therapies have demonstrated excellent safety and efficacy profiles while preserving sexual function. These modalities should be discussed with patients to ensure informed and shared decision-making. Ablative minimally invasive surgical therapies may be particularly interesting to patients who value the preservation of their sexual function.
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Affiliation(s)
- David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tiange Li
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Roseanne Ferreira
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Anna-Lisa V Nguyen
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Dean Elterman
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Minore A, Morselli S, Franzoso F, Maruzzi D, Varvello F, Toso S, Ferrari G, Siena G, Conti E, Papalia R, Uricchio F, Balsamo R, Scarpa RM, Cindolo L. Is water vapor thermal therapy safe and feasible in elderly and frail men? The Italian experience. World J Urol 2024; 42:60. [PMID: 38280069 DOI: 10.1007/s00345-023-04762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/12/2023] [Indexed: 01/29/2024] Open
Abstract
PURPOSE In recent years, water vapor thermal therapy (WVTT) has spread as minimally invasive technique in lower urinary tract symptoms due to benign prostatic hyperplasia treatment. Even if its safety and feasibility have been largely proved in young men, nobody has proved the same feasibility and safety in the elderly (men older than 75 years old). Our aim is to compare WVTT safety outcomes in men older than 75 with younger men. METHODS We prospectively collected data on men who underwent water vapor thermal therapy from 2019. We compared data on operative time, number of injections, intra-operative and post-operative complications, reinterventions rate. RESULTS We enrolled 426 patients; among these, 60 were older than 75 years old, 366 were younger. Our cohorts of patients had similar results in terms of intra-operative and post-operative complications. Operative time accounts about 11 min for both groups (p = 0.535), total number of injections was seven for young men and eight for elderly (p = 0.314). We found no intra-operative complications in elderly men group and only one in the younger group (p = 0.678), while five younger men underwent clot retention, and two elderly men experienced this complication (p = 0.239). Only one transfusion occurred in the elderly group. No differences between groups occurred in terms of length of stay, post-operative urinary retention and reintervention rate, while catheterization time was longer in the elderly men. CONCLUSION WVTT is a safe procedure in elderly patients with comparable intra-operative and post-operative complication rate in comparison with younger patients.
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Affiliation(s)
- Antonio Minore
- Department of Urology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Simone Morselli
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy
| | | | - Daniele Maruzzi
- Department of Urology, S. Maria Degli Angeli Hospital, Pordenone, Italy
| | - Francesco Varvello
- Department of Urology, Michele e Pietro Ferrero Hospital, Alba-Bra, Italy
| | - Stefano Toso
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy
| | - Giampaolo Siena
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence, Italy
| | - Enrico Conti
- Department of Urology, Levante Ligure Hospital, La Spezia, Italy
| | - Rocco Papalia
- Department of Urology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Uricchio
- Department of Urology, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Raffaele Balsamo
- Department of Urology, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | | | - Luca Cindolo
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy.
- Department of Urology, "Villa Stuart" Private Hospital, Rome, Italy.
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Santarelli V, Lombardo R, De Nunzio C. The influence of preoperative urodynamic parameters on clinical results in patients with benign prostatic hyperplasia after transurethral resection of the prostate. World J Urol 2024; 42:16. [PMID: 38197997 DOI: 10.1007/s00345-023-04763-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Valerio Santarelli
- Department of Urology, Sapienza Università di Roma, Via di Grottarossa 1089, Rome, Italy
| | - Riccardo Lombardo
- Department of Urology, Sapienza Università di Roma, Via di Grottarossa 1089, Rome, Italy.
| | - Cosimo De Nunzio
- Department of Urology, Sapienza Università di Roma, Via di Grottarossa 1089, Rome, Italy
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Leonardi R, Ambrosini F, Malinaric R, Cafarelli A, Calarco A, Colombo R, De Cobelli O, De Marco F, Ferrari G, Ludovico G, Pecoraro S, Tuzzolo D, Terrone C, Mantica G. New minimally invasive solutions for Benign Prostatic Obstruction (BPO) management: A position paper from the UrOP (Urologi Ospedalità Gestione Privata). Arch Ital Urol Androl 2023; 95:12003. [PMID: 38117214 DOI: 10.4081/aiua.2023.12003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
To the Editor, In recent years, alternative solutions have been proposed to obtain effective results comparable to TURP, which is currently considered the gold standard, and laser vapo-enucleation techniques (1, 2), but with the possibility of maintaining sexual functions. In recent years there has been a growing trend towards ejaculation preservation. Although the results of TURP (3), and most laser enucleation techniques are undoubted in the Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS) management, they often lack in the preservation of ejaculation. All the alternative recently proposed interventions (Rezum, AquaBeam, Urolift, TPLA, i-TIND, LEST) are procedures considered by some authors to be promising in both managing BPO and preserving sexual functions. However, all these methods are limited by a lack of long-term follow-up that would evaluate the efficacy over time, possible complications related to the method and the correct patient selection for a specific method. The aim of this letter is to summarize the available evidence and provide clinicians with practical recommendations on the use of the brand new minimally invasive techniques for the management of BPO. [...].
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Affiliation(s)
- Rosario Leonardi
- Urologi Ospedalità Gestione Privata (UrOP); Casa di Cura Musumeci GECAS, Gravina di Catania.
| | | | | | - Angelo Cafarelli
- Urologi Ospedalità Gestione Privata (UrOP); Urology Unit, Villa Igea, Ancona.
| | - Alessandro Calarco
- Urologi Ospedalità Gestione Privata (UrOP); Villa Pia Hospital, Via Folco Portinari 5, Rome.
| | - Renzo Colombo
- Urologi Ospedalità Gestione Privata (UrOP); Department of Urology, Vita e Salute San Raffaele University, Milan.
| | - Ottavio De Cobelli
- Urologi Ospedalità Gestione Privata (UrOP); Department of Urology, IEO European Institute of Oncology, IRCCS, Milan.
| | | | - Giovanni Ferrari
- Urologi Ospedalità Gestione Privata (UrOP); Hesperia Hospital, Modena.
| | - Giuseppe Ludovico
- Urologi Ospedalità Gestione Privata (UrOP); Ospedale Miulli, Acquaviva delle Fonti, Bari.
| | | | | | - Carlo Terrone
- IRCCS Ospedale Policlinico San Martino, Genova; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova.
| | - Guglielmo Mantica
- Urologi Ospedalità Gestione Privata (UrOP); IRCCS Ospedale Policlinico San Martino, Genova; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova.
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Woo H, Levin R, Cantrill C, Zhou S, Neff D, Sutton M, Bailen J, Darson M, Horgan J, Zantek P, Marty-Roix R. Prospective Trial of Water Vapor Thermal Therapy for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia in Subjects with a Large Prostate: 6- and 12-month Outcomes. EUR UROL SUPPL 2023; 58:64-72. [PMID: 38152482 PMCID: PMC10751540 DOI: 10.1016/j.euros.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/29/2023] Open
Abstract
Background Current guidelines recommend Rezūm water vapor thermal therapy for the treatment of benign prostatic hyperplasia (BPH) for prostate glands ranging in volume from 30 to 80 cm3. Few prospective studies have specifically evaluated the use of Rezūm for larger prostates. Objective To evaluate the safety and efficacy of water vapor thermal therapy in patients with a prostate gland >80 cm3 and ≤150 cm3. Design setting and participants In this prospective, single-arm study at seven centers in the USA, subjects were males aged >50 yr with symptomatic BPH and prostate volume of >80 cm3 and ≤150 cm3. Intervention Rezūm was used to deliver sterile water vapor via a transurethral approach to ablate targeted areas of prostate tissue. Outcome measurements and statistical analysis The primary efficacy outcome was response to therapy, defined on a per-patient basis as a ≥30% improvement in International Prostate Symptom Score (IPSS) from baseline to 6 mo. The primary safety outcome was a composite of serious device-related safety events. Secondary outcomes included catheterization for device-related retention. IPSS outcomes over time were analyzed via generalized estimating equations. Results and limitations Among 47 eligible patients, prostate volume ranged from 80.8 to 148.1 cm3. All patients completed 6-mo follow-up, and 40/47completed 12-mo follow-up. At 6 mo, 83% were treatment responders according to the primary efficacy endpoint. The mean IPSS improvement at 6 mo was 11.9 ± 7.5 points, reflecting significant improvement. The primary safety outcome was met, with no occurrence of device-related composite safety events. The study is limited by the nonrandomized design and early termination, unrelated to safety or effectiveness. Conclusions Our results are consistent with previous findings for prostate glands of up to 80 cm3, and indicate the safety and efficacy of Rezūm for BPH in patients with a larger prostate. Patient summary Rezūm therapy, in which water vapor is used to treat targeted areas of the prostate, is currently recommended for patients with benign enlargement of the prostate and a prostate size of up to 80 cm3. We found that this treatment was also effective and safe in patients with a larger prostate of 80-150 cm3.
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Affiliation(s)
- Henry Woo
- College of Health and Medicine, Australian National University and SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, Australia
| | | | | | - Shaw Zhou
- Pinellas Urology, South Pasadena, FL, USA
| | - Donald Neff
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | | | - Paul Zantek
- Boston Scientific Corporation, Marlborough, MA, USA
| | | | - Rezūm Clinical Trials Group
- College of Health and Medicine, Australian National University and SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, Australia
- Chesapeake Urology, Baltimore, MD, USA
- Urology of San Antonio, San Antonio, TX, USA
- Pinellas Urology, South Pasadena, FL, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- Houston Metro Urology, Houston, TX, USA
- First Urology, Louisville, KY, USA
- Arizona Urology Specialists, Scottsdale, AZ, USA
- Adult & Pediatric Urology, Omaha, NE, USA
- Boston Scientific Corporation, Marlborough, MA, USA
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Destefanis P, Sibona M, Vitiello F, Vercelli E, Micai L, Montefusco G, Mangione C, Bracco F, Colucci F, De Nunzio C, Gontero P. Trans - Perineal laser ablation of the prostate in high surgical risk patients affected by severe lower urinary tract symptoms related to benign prostatic obstruction. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00736-5. [PMID: 37853099 DOI: 10.1038/s41391-023-00736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND In our study, we aimed to test the efficacy and safety of Trans-Perineal Laser Ablation of the prostate (TPLA®) in the surgical treatment of high-risk Benign Prostatic Obstruction (BPO) patients. METHODS We defined a high-risk BPO patient as an elderly man affected by severe comorbidities, among which coagulation issues due to pre-existent medications or diseases. From October 2020 to June 2022, we prospectively enrolled high-risk patients affected by a moderate to severe and/or complicated BPO condition. The analysis of the efficacy of the Trans-Perineal Laser Ablation was defined as the primary endpoint of the study. Secondary endpoints were post-operative surgical complications and patient-reported quality of life. RESULTS Globally, 40 consecutive patients were enrolled. Median (IQR) age was 80 (72.5-84) years. Median Charlson Comorbidity Index was 6 (5-7). Median prostate volume was 38 (30.5-73) cc. In all cases, a TPLA® procedure was performed under local anesthesia, and patients being discharged within the same day of the procedure. A progressive reduction of median prostate volumes was reported at 3 and 6 months post-operatively, compared to baseline [38 (30.5-73) vs 35 (26-49) vs 34 (28-49) cc, p < 0.001]. Median International Prostate Symptom Score (IPSS) improved accordingly [25 (19-30) vs 10.5 (7.5-13) vs 8 (6-11.5), p < 0.001]. A permanent bladder catheter was successfully removed in 13 out of 23 (56.5%) cases. Within 90 days from surgery, 19 (47.5%) patients experienced at least one surgical complication. According to the Clavien-Dindo classification, complications were classified as grade I in 16 (40%) cases, grade II in 9 (22.5%), and grade III in 1 (2.5%). We did not observe any grade IV or V complications. CONCLUSIONS The Trans-Perineal Laser Ablation of the Prostate is a feasible, safe, and effective Minimally Invasive Surgical Technique, when offered to elderly, high-risk patients affected by severe Benign Prostatic Obstruction.
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Affiliation(s)
- Paolo Destefanis
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Mattia Sibona
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy.
| | - Federico Vitiello
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Eugenia Vercelli
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Luca Micai
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Gabriele Montefusco
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Carlotta Mangione
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Francesco Bracco
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Fulvia Colucci
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Cosimo De Nunzio
- Urology Unit, Ospedale Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Paolo Gontero
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
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Khooblall P, Bole R, Leelani N, Lundy S, Bajic P. A scoping review of ejaculatory dysfunction due to surgical treatments for benign prostatic hyperplasia: limitations of available tools for assessment and reporting. Sex Med Rev 2023; 11:375-383. [PMID: 36892248 DOI: 10.1093/sxmrev/qead002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Clinicians primarily focus on the presence or absence of anterograde ejaculation following surgery for benign prostatic hyperplasia (BPH). Failing to assess dysfunctional ejaculation and associated bother in a granular fashion can underestimate the prevalence and significance of ejaculatory dysfunction in this population. OBJECTIVES This scoping review provides critical appraisal of existing tools assessing ejaculatory function and associated bother, emphasizing the importance of adequate history-taking, preoperative counseling, and supplemental questions that should be used prior to and after treatment. METHODS A literature review was conducted using pertinent keywords from 1946 to June 2022. Eligibility criteria included men developing ejaculatory dysfunction following BPH surgery. Measured outcomes included the assessment of patient bother related to ejaculatory function, pre- and postoperative scores from the Male Sexual Health Questionnaire (MSHQ). and Danish Prostate Symptom sexual function domain (DAN-PSSsex). RESULTS Results of this study included only 10 documented patients' bother due to ejaculatory dysfunction following treatment. Pre- and postoperative MSHQ were used as the diagnostic tool in 43/49 studies, one study documented "preservation of anterograde ejaculation", and one used DAN-PSSsex. Q1-4 of the MSHQ were used in 33/43 studies, 3/43 used Q1, 3, 5-7, 1/43 used solely Q4, 1/43 used Q1-3 + Q6 and Q7, and 5/43 used the entire MSHQ. No studies used post-ejaculation urinalysis to diagnose retrograde ejaculation. Only four studies explicitly documented bother and found 25-35% of patients were bothered with a "lack of ejaculate" or "other ejaculation difficulties" during sexual activity after BPH surgery. CONCLUSIONS There are currently no studies stratifying patient bother by various components of ejaculation (force, volume, consistency, sensation of seminal expulsion, painful ejaculation, etc.) after BPH surgery. Opportunities for improvement exist in reporting ejaculatory dysfunction related to BPH treatment. A comprehensive sexual health history is needed. Further investigation into effects of BPH surgical treatments on specific characteristics of the patient's experience of ejaculation is required.
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Affiliation(s)
- Prajit Khooblall
- Center for Men's Health, Glickmassn Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Raevti Bole
- Center for Men's Health, Glickmassn Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Navid Leelani
- Center for Men's Health, Glickmassn Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Scott Lundy
- Center for Men's Health, Glickmassn Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Petar Bajic
- Center for Men's Health, Glickmassn Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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Sibona M, Destefanis P, Vercelli E, Secco S, Gontero P, Cindolo L. Ejaculation physiology and dysfunction after BPH surgery: the role of the new MISTs. Prostate Cancer Prostatic Dis 2023; 26:475-482. [PMID: 37500787 DOI: 10.1038/s41391-023-00686-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Human ejaculation can be defined as a complex and still largely unknown function. Since decades, Benign Prostatic Hyperplasia (BPH) surgery-associated loss of antegrade ejaculation has been reported as a bother by many patients. New technologies and modified surgical techniques were developed, to reduce the impact of ejaculatory dysfunction on patients' perceived quality of life. Recently, the emerging of the new Minimally Invasive Surgical Techniques (MISTs) empowered the urological surgeons with the technological means to introduce the ejaculation-sparing principles into everyday clinical practice. METHODS Our paper was conceived as a state-of-the-art analysis about the anatomical and physiological premises of the human ejaculation and their clinical application in the field of ejaculation-sparing surgery for the treatment of Lower Urinary Tract Symptoms (LUTS). Moreover, we proposed an innovative physiological model for antegrade ejaculation. RESULTS We analysed the elements of the "ejaculatory apparatus" from an anatomical point of view. We investigated the physio-pathological models of the human ejaculation, from the classical "combustion chamber" paradigm to the new evidences by which it could be overcome. Finally, we provided a synthetic literature review about the ejaculation-sparing techniques for BPH surgery. Particularly, we distinguished them between classical techniques, modified for ejaculation-preserving purposes, and the new MISTs, characterized by the introduction of new technologies and different treatment modalities. CONCLUSIONS Modified surgical techniques and new technologies opened new perspectives about human ejaculation. Previously established functional paradigms were questioned and overcome by recent clinical evidence. The new MISTs gained a prominent role in the process, opening a whole new era for BPH surgery.
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Affiliation(s)
- Mattia Sibona
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy.
| | - Paolo Destefanis
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Eugenia Vercelli
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Silvia Secco
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Gontero
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, CUrE Group, Modena, Italy
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