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Patelli G, Altieri VM, Ierardi AM, Carnevale A, Chizzoli E, Baronchelli F, Trimarchi R, Carrafiello G. Transperineal Laser Ablation of the Prostate for Symptomatic Benign Prostatic Hyperplasia: Long-Term Follow-Up in 40 Patients. J Vasc Interv Radiol 2024; 35:1187-1193. [PMID: 38705571 DOI: 10.1016/j.jvir.2024.04.023] [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: 10/10/2023] [Revised: 04/09/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024] Open
Abstract
PURPOSE To evaluate the durability, effectiveness, and safety of transperineal laser ablation (TPLA) of the prostate. MATERIALS AND METHODS Patients with symptomatic benign prostatic hyperplasia (BPH) underwent TPLA with a 1,064-nm continuous-wave diode laser. International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual (PVR), and prostate volume were evaluated at baseline and successive timepoints. RESULTS Forty prospectively enrolled patients had follow-up of ≥36 months; median duration of follow-up was 57 months (range, 36-76 months). Compared with baseline, the median reduction in IPSS at 12-month follow-up was 74% (interquartile range [IQR], 60%-81%) (P < .001). Median QoL score at 12 months was improved from 5 (IQR, 4-5) at baseline to 1 (IQR, 0-1) (P < .001). Median PVR at 12 months decreased from 108 mL (IQR, 38-178 mL) to 13.5 mL (IQR, 0-40.5 mL) (P < .001), a median reduction of 88% (IQR, 61%-100%). At 12 months, median prostate volume was significantly reduced from 66 mL (IQR, 48.5-86.5 mL) to 46 mL (IQR, 36-65 mL) (P < .001), a median reduction of 32% (IQR, 21%-45%). For all of these parameters, the benefit of TPLA persisted at last follow-up, and all changes were statistically significant compared with baseline. There were no intraprocedural adverse events; periprocedural adverse events consisted of 1 case of prostatitis and 1 case of urinary tract infection (both Society of Interventional Radiology [SIR] Grade I). CONCLUSIONS TPLA for symptomatic BPH produced durable benefits across a range of clinical outcomes and was well tolerated in follow-up at median duration of 57 months.
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Affiliation(s)
| | - Vincenzo Maria Altieri
- Urology Department, Humanitas Gavazzeni, Bergamo, Italy - Università degli Studi del Molise
| | - Anna Maria Ierardi
- Radiology Department, Università Statale degli Studi Di Milano, IRCCS Policlinico, Milano, Italy
| | - Aldo Carnevale
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | | | | | - Gianpaolo Carrafiello
- Radiology Department, Università Statale degli Studi Di Milano, IRCCS Policlinico, Milano, Italy
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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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Licari LC, Bologna E, Manfredi C, Franco A, Ditonno F, De Nunzio C, Antonelli A, Simone G, De Sio M, Cindolo L, Olweny EO, Cherullo EE, Leonardo C, Autorino R. Incidence and management of BPH surgery-related urethral stricture: results from a large U.S. database. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00841-z. [PMID: 38714780 DOI: 10.1038/s41391-024-00841-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/10/2024]
Abstract
INTRODUCTION AND OBJECTIVES Urethral stricture (US) is a well-known complication after surgical treatment of benign prostatic hyperplasia (BPH). This study aimed to evaluate the contemporary incidence of the US after different types of BPH surgery, to identify associated risk factors and to assess its management. METHODS A retrospective analysis was conducted using the PearlDiver™ Mariner database, containing de-identified patient records compiled between 2011 and 2022. Specific International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify population characteristics and outcomes. All the most employed surgical procedures for BPH treatment were considered. Multivariable logistic regression was employed to evaluate factors associated with diagnosis of post-operative US. RESULTS Among 274,808 patients who underwent BPH surgery, 10,918 developed post-operative US (3.97%) within 12 months. Higher incidence of US was observed following TURP (4.48%), Transurethral Incision of the Prostate (TUIP) (3.67%), Photoselective Vaporization of the Prostate (PVP) (3.92%), HoLEP/ThuLEP (3.85%), and open Simple Prostatectomy (SP) (3.21%). Lower incidence rates were observed after laparoscopic\robot-assisted SP (1.76%), Aquablation (1.59%), Prostatic Urethral Lift (PUL) (1.07%), Rezum (1.05%), and Prostatic Artery Embolization (PAE) (0.65%). Multivariable analysis showed that patients undergoing PUL, Rezum, Aquablation, PAE, and PVP were associated with a reduced likelihood of developing US compared to TURP. US required surgical treatment in 18.95% of patients, with direct visual internal urethrotomy (DVIU) and urethroplasty performed in 14.55% and 4.50% of cases, respectively. Urethral dilatation (UD) in an outpatient setting was the primary management in most cases (76.7%). CONCLUSIONS The present analysis from a contemporary large dataset suggests that the incidence of US after BPH surgery is relatively low (<5%) and varies among procedures. Around 94% of US cases following BPH surgery are managed using minimally invasive treatment approaches such as UD and DVIU.
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Affiliation(s)
- Leslie Claire Licari
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca Cindolo
- Department of Urology, Villa Stuart Hospital, Rome, Italy
| | | | | | - Costantino Leonardo
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
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Busetto GM, Lombardo R, De Nunzio C, Santoro G, Tocci E, Schiavone N, Tubaro A, Carrieri G, Kaplan SA, Herrmann TRW. Ejaculation sparing of classic and minimally invasive surgical treatments of LUTS/BPH. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00834-y. [PMID: 38615071 DOI: 10.1038/s41391-024-00834-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The surgical landscape for Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Hyperplasia (BPH) has evolved with the introduction of Minimally Invasive Surgical Therapies (MISTs), recognizing the impact of sexual function on patients' well-being, and prioritizing ejaculation-sparing approaches. METHODS This systematic review explored ejaculation sparing after classic endoscopic procedures and MISTs (iTind, Rezūm, Urolift, Aquablation, and TPLA) and a literature search yielded 41 studies. RESULTS While all procedures demonstrated efficacy in improving LUTS/BPH symptoms (IPSS, QoL, Qmax), a subset of studies evaluated ejaculatory function. Positive outcomes were noted, challenging the historical association of BPH surgeries with ejaculatory dysfunction. Variations in study design, patient cohorts, and limited long-term data present challenges. Notably, the lack of baseline specificity, use of alpha-blockers, and non-specific sexual function assessments underscore potential biases. CONCLUSIONS Despite limitations, the review tentatively concluded that MISTs, including iTind, Rezūm, Urolift, Aquablation, and TPLA, appear comparable in sparing ejaculation. Long-term studies are essential to validate sustainability, and comparative research should assess trade-offs between MISTs and traditional surgeries. Incorporating patient-reported outcomes and quality of life assessments will enhance future investigations, refining MISTs as standard therapeutic options for LUTS/BPH.
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Affiliation(s)
- Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy.
| | | | | | | | - Edoardo Tocci
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Nicola Schiavone
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Andrea Tubaro
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, Stellenbosch, South Africa
- Hannover Medical School, Hannover, Germany
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Cindolo L, Al Jaafari F, De Nunzio C. The times have changed. Let the urologists change! Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00828-w. [PMID: 38575746 DOI: 10.1038/s41391-024-00828-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Luca Cindolo
- Dept of Urology, "Villa Stuart" Private Hospital, Rome, and Centro Urologico Europeo, Modena, Italy.
| | - Feras Al Jaafari
- Department of Urology, Victoria Hospital, NHS Fife, Kirkcaldy, Scotland
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Busetto GM, Checchia A, Recchia M, Tocci E, Falagario UG, Annunziata G, Annese P, d’Altilia N, Mancini V, Ferro M, Crocetto F, Tataru OS, Gianfrancesco LD, Porreca A, Giudice FD, Berardinis ED, Bettocchi C, Cormio L, Carrieri G. Minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS): promise or panacea? Asian J Androl 2024; 26:135-143. [PMID: 37921510 PMCID: PMC10919430 DOI: 10.4103/aja202357] [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: 06/29/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023] Open
Abstract
ABSTRACT The increasing importance of treatment of lower urinary tract symptoms (LUTS), while avoiding side effects and maintaining sexual function, has allowed for the development of minimally invasive surgical therapies (MISTs). Recently, the European Association of Urology guidelines reported a paradigm shift from the management of benign prostatic hyperplasia (BPH) to the management of nonneurogenic male LUTS. The aim of the present review was to evaluate the efficacy and safety of the most commonly used MISTs: ablative techniques such as aquablation, prostatic artery embolization, water vapor energy, and transperineal prostate laser ablation, and nonablative techniques such as prostatic urethral lift and temporarily implanted nitinol device (iTIND). MISTs are becoming a new promise, even if clinical trials with longer follow-up are still lacking. Most of them are still under investigation and, to date, only a few options have been given as a recommendation for use. They cannot be considered as standard of care and are not suitable for all patients. Advantages and disadvantages should be underlined, without forgetting our objective: treatment of LUTS and re-treatment avoidance.
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Affiliation(s)
- Gian Maria Busetto
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Andrea Checchia
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
- Urology Unit, “G. Tatarella” Hospital, Cerignola 71042, Italy
| | - Marco Recchia
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
- Urology Unit, “G. Tatarella” Hospital, Cerignola 71042, Italy
| | - Edoardo Tocci
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | | | | | - Pasquale Annese
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Nicola d’Altilia
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Vito Mancini
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Matteo Ferro
- Urology Unit, European Institute of Oncology (IEO) IRCCS, Milan 20141, Italy
| | | | - Octavian Sabin Tataru
- G. E. Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures 540142, Romania
| | - Luca Di Gianfrancesco
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, Padua 35128, Italy
| | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, Padua 35128, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Roma 00161, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Roma 00161, Italy
| | - Carlo Bettocchi
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Luigi Cormio
- University of Foggia, Foggia 71122, Italy
- Urology Unit, “L. Bonomo” Hospital, Andria 76123, Italy
| | - Giuseppe Carrieri
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
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Bertolo R, Vittori M. Transperineal laser ablation of prostate: is enough as good as a feast? Minerva Urol Nephrol 2024; 76:127-130. [PMID: 38426427 DOI: 10.23736/s2724-6051.23.05528-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Riccardo Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy -
| | - Matteo Vittori
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
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Tayeb W, Azhar RA, Subahi M, Munshi S, Qarni A, Bakhsh A, Sejiny M, Almohaisen T, Alammari A, Elkoushy MA. Rezŭm water vaporization therapy versus transurethral resection of the prostate in the management of refractory urine retention: matched pair comparative multicenter experience. World J Urol 2024; 42:48. [PMID: 38244100 DOI: 10.1007/s00345-023-04739-8] [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: 08/08/2023] [Accepted: 11/15/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE To compare the efficacy of Rezūm with a matched cohort of patients undergoing transurethral resection of the prostate (TURP) for catheter-dependent urine retention secondary to benign prostate hyperplasia (BPH). METHODS A retrospective review was performed for consecutive catheter-dependent patients who underwent Rezūm for BPH. Patients were matched and compared with a similar cohort undergoing TURP, using non-inferiority analysis on propensity score-matched patient pairs. Patients were followed up at 1, 3, 6 and 12 months by international prostate symptoms score (IPSS), quality of life (QoL) index, peak flow rate (Qmax) and postvoid residual urine (PVR). RESULTS Eighty-one patients undergoing Rezūm were compared with equal number of matched patients who undergoing TURP. Patients undergoing Rezūm experienced significantly shorter operation time (25.5 ± 8.7 vs. 103.4 ± 12.6 min; p < 0.001), lower intraoperative bleeding (2.4% vs. 20.7%, p < 0.001), shorter hospital stay (1.2 ± 0.9 vs. 2.4 ± 1.3 d, p < 0.001) and longer catheter time (12.6 ± 6.0 vs. 2.3 ± 1.2 d, p < 0.001), with no need for transfusion. Successful postoperative voiding was comparable between both arms (90.2% vs. 92.7%, p = 0.78), respectively. Despite patients undergoing TURP had significantly better voiding outcomes after 1 and 3 months, both groups were comparable after six and 12 months in terms of mean IPSS (11.1 ± 6.4 vs. 10.8 ± 3.4, p = 0.71), QoL indices (2.4 ± 1.6 vs. 2.1 ± 2.3, p = 0.33) and Qmax (22.0 ± 7.7 v. 19.8 ± 6.9 ml/sec, p = 0.06). CONCLUSION This study supports the safety and efficacy of Rezūm in the management of catheter-dependent patients secondary to BPH, with comparable functional outcomes to TURP. Until a randomized clinical comparison is available, long-term data are crucially recommended to compare the recurrence and reoperation rates.
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Affiliation(s)
- Waseem Tayeb
- Department of Surgery, Division of Urology, King Abdullah Medical City at Holy Capital, Makkah, Saudi Arabia.
| | - Raed A Azhar
- Faculty of Medicine, Urology Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohnna Subahi
- Department of Surgery, Division of Urology, King Abdullah Medical City at Holy Capital, Makkah, Saudi Arabia
| | - Sameer Munshi
- Department of Surgery, Division of Urology, King Abdullah Medical City at Holy Capital, Makkah, Saudi Arabia
| | - Abdulrahman Qarni
- Urology Department, Dr Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Abdulaziz Bakhsh
- Urology Department, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Majid Sejiny
- Urology Department, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Turkey Almohaisen
- Urology Department, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Adel Alammari
- Urology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohamed A Elkoushy
- Faulty of Medicine, Urology Department, Suez Canal University, Ismailia, Egypt
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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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