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Harman A, Toth R, Mobley Z, Sartin D, Karamanian A. MRI-guided transrectal prostate laser ablation for benign prostatic hypertrophy: a retrospective cohort study. LA RADIOLOGIA MEDICA 2024; 129:1412-1423. [PMID: 39154318 DOI: 10.1007/s11547-024-01855-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/04/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE To investigate whether MRI-guided transrectal laser ablation is safe and effective for the treatment of lower urinary tract symptoms caused by BPH. MATERIALS AND METHODS This single-center retrospective cohort study evaluated men who underwent MRI-guided transrectal laser ablation for BPH between February 2017 and July 2021. Age, prostate-specific antigen, prostate volume, prior surgical BPH treatments if any, International Prostate Symptom Score (IPSS) and Sexual Health Inventory of Men (SHIM) were collected. The primary outcome measures assessed were change in IPSS and SHIM 6, 12 and 24 months after laser ablation and adverse events. RESULTS Fifty-two patients were included, having completed at least one follow-up survey. The mean patient age was 62.9 ± 5.7 years, and mean prostate volume was 80.2 ± 39.2 cc. Eighteen patients (34.6%) had received a prior BPH treatment. The IPSS scores dropped an average of 16.7 ± 7.0 (p < 0.001), 16.9 ± 7.5 (p < 0.001) and 17.1 ± 7.2 (p < 0.001) points from baseline at 6, 12 and 24 months, respectively. There was no statistically significant difference in IPSS score drop between patients who had received a prior BPH procedure and those who had not (p = 0.628). The SHIM scores showed a statistically insignificant increase at all time points. Nineteen patients (36.5%) reported a complication. There were 12 grade II complications (23%) and seven grade I complications (13.5%). There were no grade III or higher complications. CONCLUSION Transrectal MRI-guided focal laser ablation is safe and effective for the treatment of lower urinary tract symptoms caused by BPH, with a significant improvement in symptom severity after 2 years.
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Affiliation(s)
- Aaron Harman
- Halo Prostate Laser Center, 6624 Fannin St., Suite 2580, Houston, TX, 77030, USA.
| | | | - Zahra Mobley
- Halo Prostate Laser Center, 6624 Fannin St., Suite 2580, Houston, TX, 77030, USA
| | - Donnie Sartin
- Halo Prostate Laser Center, 6624 Fannin St., Suite 2580, Houston, TX, 77030, USA
| | - Ara Karamanian
- Halo Prostate Laser Center, 6624 Fannin St., Suite 2580, Houston, TX, 77030, USA
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2
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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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3
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Iacovelli V, Carilli M, Bertolo R, Forte V, Vittori M, Filippi B, Di Giovanni G, Cipriani C, Petta F, Maiorino F, Signoretti M, Antonucci M, Guidotti A, Travaglia S, Caputo F, Manenti G, Bove P. Transperineal Laser Ablation for Focal Therapy of Localized Prostate Cancer: 12-Month Follow-up Outcomes from a Single Prospective Cohort Study. Cancers (Basel) 2024; 16:2620. [PMID: 39123349 PMCID: PMC11311001 DOI: 10.3390/cancers16152620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the oncological and functional outcomes of transperineal laser ablation (TPLA) as the focal therapy for localized prostate cancer (PCa) after a 12-month follow-up. MATERIALS AND METHODS Patients with low- and intermediate-risk localized PCa were prospectively treated with focal TPLA between July 2021 and December 2022. The inclusion criteria were the following: clinical stage < T2b; PSA < 20 ng/mL; International Society of Urological Pathology (ISUP) grade ≤ 2; MRI-fusion biopsy-confirmed lesion classified as PI-RADS v2.1 ≥ 3. Intra-, peri-, and post-operative data were collected. Variables including age, PSA, prostate volume (PVol), Charlson's Comorbidity Index (CCI), International Prostate Symptom Score (IPSS) with QoL score, International Index of Erectile Function (IIEF-5), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD) were collected at baseline and at 3, 6 and 12 months after TPLA. Post-operative mpMRI was performed at 3 and 12 months. Finally, all patients underwent prostatic re-biopsy under fusion guidance at 12 months. The success of this technique was defined as no recurrence in the target treated lesion at the 12-month follow up. RESULTS Twenty-four patients underwent focal TPLA. Baseline features were age [median 67 years (IQR 12)], PSA [5.7 ng/mL (3.9)], PVol [49 mL (27)], CCI [0 (0)], IPSS [11 (9)], IPSS-QoL [2 (2)], IIEF-5 [21 (6)], ICIQ-SF [0 (7)], MSHQ-EjD ejaculation domain [14 (4)] and bother score [0 (2)]. Median operative time was 34 min (IQR 12). Median visual analogue scale (VAS) 6 h after TPLA was 0 (IQR 1). The post-operative course was regular for all patients, who were discharged on the second post-operative day and underwent catheter removal on the seventh post-operative day. No patient had incontinence at catheter removal. A significant reduction in PSA (p = 0.01) and an improvement in IPSS (p = 0.009), IPSS-QoL (p = 0.02) and ICIQ-SF scores (p = 0.04) compared to baseline were observed at the 3-month follow-up. Erectile and ejaculatory functions did not show any significant variation during the follow-up. No intra- and peri-operative complications were recorded. Three Clavien-Dindo post-operative complications were recorded (12%): grade 1 (two cases of urinary retention) and grade 2 (one case of urinary tract infection). At the 12-month follow-up, eight patients showed mpMRI images referable to suspicious recurrent disease (PIRADS v2.1 ≥ 3). After re-biopsy, 7/24 patients' (29%) results were histologically confirmed as PCa, 3 of which were recurrences in the treated lesion (12.5%). The success rate was 87.5%. CONCLUSIONS The focal TPLA oncological and functional results seemed to be encouraging. TPLA is a safe, painless, and effective technique with a good preservation of continence and sexual outcomes. Recurrence rate at 12 months was about 12.5%.
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Affiliation(s)
- Valerio Iacovelli
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
| | - Marco Carilli
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
| | - Riccardo Bertolo
- Department of Urology, AOUI Verona, University of Verona, 37129 Verona, Italy
| | - Valerio Forte
- Radiology Unit, San Carlo di Nancy Hospita, GVM Care and Research, 00165 Rome, Italy
| | - Matteo Vittori
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
| | - Beatrice Filippi
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
| | - Giulia Di Giovanni
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
| | - Chiara Cipriani
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
| | - Filomena Petta
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
| | - Francesco Maiorino
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
| | - Marta Signoretti
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
| | - Michele Antonucci
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
| | - Alessio Guidotti
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
| | - Stefano Travaglia
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
| | - Francesco Caputo
- Radiology Unit, San Carlo di Nancy Hospita, GVM Care and Research, 00165 Rome, Italy
| | - Guglielmo Manenti
- Department of Biomedicine and Prevention, Radiology Unit, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Pierluigi Bove
- Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, 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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5
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Manenti G, Perretta T, Nezzo M, Fraioli FR, Carreri B, Gigliotti PE, Micillo A, Malizia A, Di Giovanni D, Ryan CP, Garaci FG. Transperineal Laser Ablation (TPLA) Treatment of Focal Low-Intermediate Risk Prostate Cancer. Cancers (Basel) 2024; 16:1404. [PMID: 38611082 PMCID: PMC11011049 DOI: 10.3390/cancers16071404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This interventional pilot study aimed to evaluate the short-term (3 years) efficacy of focal laser ablation (FLA) in treating the index lesion of low-intermediate-risk prostate cancer, along with assessing the safety of the procedure (ClinicalTrials.gov ID NCT04045756). Methods: Forty patients aged between 46 and 86 with histologically proven organ-confined prostate cancer and low-to-intermediate progression risk were included. FLA was performed under percutaneous fusion magnetic resonance/ultrasound guidance in a Day Hospital setting under local anesthesia. Patients underwent regular clinical and functional assessments through the international index of erectile function (IIEF-5) and the International Prostatism Symptom Score (IPSS), PSA measurements, post-procedure MRI scans, and biopsies at 36 months or if positive findings were detected earlier. Statistical analyses were conducted to assess trends in PSA levels and cavity dimensions over time. Results: Forty patients were initially included, with fifteen lost to follow-up. At 36 months, a mean PSA reduction of 60% was observed, and 80% of MRI scans showed no signs of in-field clinically significant residual/recurrent cancer. Biopsies at 36 months revealed no malignant findings in 20 patients. No deterioration in sexual function or urinary symptoms was recorded. Conclusions: FLA appears to be safe, feasible, and effective in the index lesion treatment of low-intermediate-risk prostate cancer, with a high rate of tumor eradication and preservation of quality of life.
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Affiliation(s)
- Gugliemo Manenti
- Diagnostic Imaging and Interventional Radiology Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Tommaso Perretta
- Diagnostic Imaging and Interventional Radiology Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Marco Nezzo
- Diagnostic Imaging and Interventional Radiology Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Federico Romeo Fraioli
- Diagnostic Imaging and Interventional Radiology Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Beatrice Carreri
- Diagnostic Imaging and Interventional Radiology Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Paola Elda Gigliotti
- Diagnostic Imaging and Interventional Radiology Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Andrea Micillo
- Diagnostic Imaging and Interventional Radiology Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Andrea Malizia
- Diagnostic Imaging and Interventional Radiology Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Daniele Di Giovanni
- Industrial Engineering, University of Rome Tor Vergata Engineering Macro Area, 00133 Rome, Italy
| | - Colleen Patricia Ryan
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Francesco Giuseppe Garaci
- Diagnostic Imaging and Interventional Radiology Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
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6
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Cocci A, Pezzoli M, Bianco F, Blefari F, Bove P, Cornud F, De Rienzo G, Destefanis P, Di Trapani D, Giacobbe A, Giovanessi L, Laganà A, Lughezzani G, Manenti G, Muto G, Patelli G, Pinzi N, Regusci S, Russo GI, Salamanca JI, Salvi M, Silvestri L, Verweij F, Walser E, Bertolo RG, Iacovelli V, Bertaccini A, Marchiori D, Davila H, Ditonno P, Gontero P, Iapicca G, M De Reijke T, Ricapito V, Pellegrini P, Minervini A, Serni S, Sessa F. Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project. Asian J Urol 2024; 11:271-279. [PMID: 38680587 PMCID: PMC11053328 DOI: 10.1016/j.ajur.2023.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2024] Open
Abstract
Objective To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method. Methods Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized. Results Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations. Conclusion Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.
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Affiliation(s)
- Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marta Pezzoli
- Urology Section, University of Florence, Florence, Italy
| | | | | | - Pierluigi Bove
- Torvergata Oncoscience Research Centre of Excellence, TOR, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Francois Cornud
- Department of Radiology, Hôpital Cochin, Paris Descartes University, Paris, France
| | - Gaetano De Rienzo
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Paolo Destefanis
- Unit of Urology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Danilo Di Trapani
- Urology Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | | | - Luca Giovanessi
- Urology Unit, Surgical Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Antonino Laganà
- Departement of Urology, “S.Giovanni Evangelista” Hospital, Tivoli, Italy
| | - Giovanni Lughezzani
- Humanitas Clinical and Research Center–IRCCS, Department of Urology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Guglielmo Manenti
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome “Tor Vergata”, Rome, Italy
| | - Gianluca Muto
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianluigi Patelli
- Department of Interventional Radiology, Pesenti-Fenaroli Hospital-ASST Bergamo Est, Alzano Lombardo, Italy
| | - Novello Pinzi
- Department of Urology, University of Siena, Siena, Italy
| | - Stefano Regusci
- Swiss International Prostate Center, Geneva, Switzerland
- Clinique Générale Beaulieu, Geneva, Switzerland
| | | | - Juan I.M. Salamanca
- Department of Urology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
- Lyx Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain
| | - Matteo Salvi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Luigi Silvestri
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy
| | - Fabrizio Verweij
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Eric Walser
- Department of Radiology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Riccardo G. Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Alessandro Bertaccini
- Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Debora Marchiori
- Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Hugo Davila
- Florida Healthcare Specialist, Urology and Minimally Invasive Surgery, Florida Cancer Specialist and Research Institute, Vero Beach, FL, USA
- Department of Surgery, Division of Urology and Gynecology, Sebastian River Medical Center, Sebastian, FL, USA
| | - Pasquale Ditonno
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Paolo Gontero
- Department of Urology, Molinette Hospital, University of Torino School of Medicine, Turin, Italy
| | | | - Theo M De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Vito Ricapito
- Department of Urology, Policlinico di Bari, Bari, Italy
| | - Pierluca Pellegrini
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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7
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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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8
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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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9
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Porto JG, Titus R, Camargo F, Bhatia A, Ahie N, Blachman-Braun R, Malpani A, Lopategui DM, Herrmann TRW, Marcovich R, Shah HN. Minimally invasive techniques in quest of Holy Grail of surgical management of enlarged prostates: a narrative review. World J Urol 2024; 42:35. [PMID: 38217727 DOI: 10.1007/s00345-023-04747-8] [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: 09/28/2023] [Accepted: 12/05/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE Past decade has seen a renewed interest in minimally invasive surgical techniques (MISTs) for management of enlarged prostate. This narrative review aims to explore newer MIST for benign prostatic hyperplasia (BPH) which are not yet integrated into established societal guidelines. METHODS We conducted a literature search across PubMed, Google Scholar, and FDA ClinicalTrials.gov databases on June 1st, 2023, to identify studies published within the past decade exploring various MISTs for BPH. Additionally, we gathered insights from abstracts presented in meetings of professional associations and corporate websites. We broadly classified these procedures into three distinct categories: energy-based, balloon dilation, and implant/stent treatments. We collected detail information about the device, procedure details, its inclusion and exclusion criteria, and outcome. RESULTS Our review reveals that newer energy-based MISTs include Transperineal Laser Ablation, Transurethral Ultrasound Ablation, and High-Intensity Focused Ultrasound. In the sphere of balloon dilation, Transurethral Columnar Balloon Dilation and the Optilume BPH Catheter System were gaining momentum. The noteworthy implants/stents that are on horizon include Butterfly Prostatic Retraction Device, Urocross Expander System, Zenflow Spring System, and ProVee Urethral Expander System. CONCLUSION The exploration of various MISTs reflects ongoing efforts to enhance patient care and address limitations of existing treatments. This review provides a bird-eye view and valuable insights for urologists and researchers seeking to navigate the dynamic landscape of MISTs in the quest for effective and minimally invasive solutions for enlarged prostates.
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Affiliation(s)
- Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Renil Titus
- Seth GS Medical College, KEM Hospital, Mumbai, India
| | - Feres Camargo
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ansh Bhatia
- Seth GS Medical College, KEM Hospital, Mumbai, India
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Nehizena Ahie
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ankur Malpani
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Diana M Lopategui
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA.
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10
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van Kollenburg R, van Riel L, Bloemen P, de Reijke T, Beerlage H, de Bruin D, Oddens J. Transperineal laser ablation as treatment for benign prostatic obstruction: Safety, feasibility and functional outcomes-A pilot study. BJUI COMPASS 2024; 5:52-59. [PMID: 38179027 PMCID: PMC10764162 DOI: 10.1002/bco2.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 01/06/2024] Open
Abstract
Background Standard surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) requires anaesthesia and hospitalization. Transperineal laser ablation (TPLA) is a novel minimally invasive treatment for BPO, which has been performed using local anaesthetics and conscious sedation. Objectives The aim of this study is to assess safety, feasibility and functional outcomes of TPLA for the treatment of LUTS in men fit also for standard surgery. Methods This prospective, multicentre, interventional pilot study included 20 patients. Eligible patients were men ≥40 years of age, with urodynamically proven bladder outlet obstruction, a peak urinary flow of 5-15 mL/s and a prostate volume of 30-120 cc. All subjects underwent Soractelite™ TPLA using the Echolaser® X4 system. Two to four fibres were placed in the prostate, whereafter laser light induced coagulative necrosis. Twelve months of follow-up included uroflowmetry, an ultrasound of the prostate and PROMs (IPSS and IIEF). Results Twenty patients were treated with TPLA using local anaesthetics and optional sedation. Sixteen patients were treated in an outpatient setting, using only local anaesthetics in 12 of them; four were treated in the operating room, whereof two under general anaesthesia. No device related adverse events occurred, nor did any grade ≥3 adverse events during follow-up. Post-TPLA, 10 men continued spontaneous voiding, and 10 men developed a urinary retention treated by a temporary indwelling catheter for 15.2 ± 3.5 days. At 12 months, Qmax improved from 9.7 ± 3.5 to 14.9 ± 6.0 (p = 0.015), IPSS improved from 21.3 ± 5.2 to 10.9 ± 5.5 (p < 0.0001), QoL improved from 4.9 ± 0.9 to 1.9 ± 1.1 (p < 0.0001), IIEF-15 total score remained stable and 11/13 patients (85%) preserved antegrade ejaculation. Conclusions TPLA is a safe and feasible treatment for men with LUTS due to BPO. TPLA can be performed in an outpatient setting under only local anaesthetics. Functional and quality of life outcomes improved significantly at 12 months, and erectile function remained stable.
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Affiliation(s)
- Rob van Kollenburg
- UrologyAmsterdam University Medical CentresAmsterdamThe Netherlands
- Biomedical Engineering and PhysicsAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Luigi van Riel
- UrologyAmsterdam University Medical CentresAmsterdamThe Netherlands
- Biomedical Engineering and PhysicsAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Paul Bloemen
- Biomedical Engineering and PhysicsAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Theo de Reijke
- UrologyAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Harrie Beerlage
- UrologyAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Daniel de Bruin
- UrologyAmsterdam University Medical CentresAmsterdamThe Netherlands
- Biomedical Engineering and PhysicsAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Jorg Oddens
- UrologyAmsterdam University Medical CentresAmsterdamThe Netherlands
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11
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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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12
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Canat HL, Gurbuz C, Bozkurt M. Transurethral resection of the prostate (TURP) versus transperineal laser ablation (TPLA) due to benign prostatic hyperplasia (BPH): prospective and comparative study. Int Urol Nephrol 2023; 55:2747-2752. [PMID: 37498422 DOI: 10.1007/s11255-023-03717-8] [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: 04/16/2023] [Accepted: 07/08/2023] [Indexed: 07/28/2023]
Abstract
AIM We aimed to compare the first-year results of Transurethral resection of the prostate (TURP), the gold standard method, and Transperineal laser ablation (TPLA) techniques. MATERIAL AND METHODS This study was designed as a prospective, randomized, controlled, and single-center and was conducted between November 2021 and February 2023. TURP candidates were included in the study. Demographic data and perioperative data were recorded. Preoperative and first-year International Prostate Symptom Score (IPSS), International Erectile Function Index (IIEF-5), Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD), QoL, peak urinary flow rate (Qmax), prostate volume (PV) and postvoid residual (PVR) data were recorded. RESULTS Fifty patients were included in the study and were assigned to equal numbers of groups. TPLA group had a higher ASA score (p = 0.03). There was improvement in IPSS, Qmax, and PVR parameters compared to baseline values in both groups at 1 year (p < 0.01). The improvement in Qmax was better in the TURP group (p < 0.01). IIEF-5 score was similar between groups (p = 0.83 and p = 0.12, respectively). The MSHQ scores in the first year did not change according to their baseline values in the TPLA group (p = 0.54 and p = 0.34, respectively). CONCLUSION According to the first-year results of TPLA, the symptomatic improvement effect without sacrificing ejaculatory functions is comparable to TURP. We think that this method will can be an alternative, especially for patients who want to avoid ejaculatory dysfunction, who have a high risk of anesthesia, and whose anticoagulant/antiplatelet therapy cannot be discontinued.
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Affiliation(s)
- Halil Lutfi Canat
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Basaksehir Olimpiyat Bulvarı yolu, Basaksehir, 34480, Istanbul, Turkey
| | - Cenk Gurbuz
- Department of Urology, Osmanoglu Hospital, Istanbul, Turkey
| | - Muammer Bozkurt
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Basaksehir Olimpiyat Bulvarı yolu, Basaksehir, 34480, Istanbul, Turkey.
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13
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Manenti G, Nezzo M, Ryan CP, Fraioli FR, Carreri B, Gigliotti PE, Angeloni C, Di Pietro F, De Angeli M, Perretta T, D'Angelillo RM, Garaci FG. Transperineal laser ablation (TPLA) with ultrasound/MRI fusion guidance in the treatment of localized radiotherapy-resistant prostate cancer. BJR Open 2023; 5:20230042. [PMID: 37942495 PMCID: PMC10630978 DOI: 10.1259/bjro.20230042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/10/2023] [Accepted: 09/06/2023] [Indexed: 11/10/2023] Open
Abstract
Objective The objective of this study was to assess the technical feasibility, safety, and efficacy of transperineal laser ablation (TPLA) guided by ultrasound/magnetic resonance (MR) fusion as a salvage treatment for refractory focal prostate cancer. Methods A total of five patients who had undergone radiation therapy (RT) for prostate carcinoma and biochemical recurrence, confirmed by both prostate-specific antigen (PSA) levels and MRI (3T mpMRI), were enrolled in this study. Focal ablation was performed using a 1064 nm diode laser. Post-ablation follow-up was conducted for a duration of 18 months, which included regular PSA sampling, 3T mpMRI, and ultrasound/MR fusion-guided biopsies systematic and targeted at the site of the focal treatment. Results The focal ablation procedure was carried out in an outpatient setting regimen with optimal clinical and biochemical outcomes. No recurrence was detected throughout the follow-up period. Conclusion TPLA focal treatment effectively manages local recurrences of RT refractory prostate cancer without side-effects or complications. Preservation of quality of life and functional outcomes, along with a >70% reduction in PSA, were achieved. Advances in knowledge Our study investigated TPLA as a salvage treatment for low-risk recurrent prostate cancer after RT, demonstrating its tolerability, feasibility, and effectiveness.
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Affiliation(s)
| | - Marco Nezzo
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | | | - Federico Romeo Fraioli
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Beatrice Carreri
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Paola Elda Gigliotti
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Cecilia Angeloni
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Di Pietro
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Martina De Angeli
- Radiotherapy Unit, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
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14
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Laganà A, Di Lascio G, Di Blasi A, Licari LC, Tufano A, Flammia RS, De Carolis A. Ultrasound-guided SoracteLite™ transperineal laser ablation (TPLA) of the prostate for the treatment of symptomatic benign prostatic hyperplasia (BPH): a prospective single-center experience. World J Urol 2023; 41:1157-1162. [PMID: 36853444 PMCID: PMC10160153 DOI: 10.1007/s00345-023-04322-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/28/2023] [Indexed: 03/01/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of ultrasound-guided transperineal laser ablation (TPLA) in patients with symptomatic BPH. MATERIALS AND METHODS From January 2020 to January 2022, 63 prospectively enrolled patients underwent TPLA with a 1064-nm continuous-wave diode laser (EchoLaser, Elesta SpA). Primary endpoints were the change in IPSS, QoL, Qmax, PVR and prostate volume at 3 and 12 months. RESULTS At 3 months, IPSS improved from 20.8 ± 7.4 to 11.0 ± 6.6 (p < 0.001), QoL from 4.7 ± 1.4 to 1.5 ± 1.2 (p < 0.001) and Qmax from 8.6 ± 3.5 mL/s to 13.2 ± 5.7 mL/s (p = 0.083). PVR decreased from 124.8 ± 115.4 mL to 43.6 ± 53.6 mL (p < 0.001), and prostate volume decreased from 63.6 ± 29.7 mL to 45.6 ± 21.8 mL (p = 0.003). At 12 months, IPSS improved from 20.8 ± 7.4 to 8.4 ± 5.9 (p < 0.001), QoL from 4.7 ± 1.4 to 1.2 ± 0.8 (p < 0.001), and Qmax from 8.6 ± 3.5 mL/s to 16.2 ± 4.3 mL/s (p = 0.014). PVR decreased from 124.8 ± 115.4 mL to 40.6 ± 53.6 mL (p = 0.003), and prostate volume decreased from 63.6 ± 29.7 mL to 42.8 ± 14.2 mL (p = 0.071). Transient complications consisted of two patients with prostatic abscess (Clavien-Dindo grade IIIa) and one patient with orchitis (Clavien-Dindo grade II). CONCLUSIONS TPLA for symptomatic BPH provides clinical benefits at 3 and 12 months, and the treatment is well tolerated.
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Affiliation(s)
| | - Giovanni Di Lascio
- Ospedale San Giovanni Evangelista, Tivoli, Rome, Italy. .,Policlinico Umberto I, Rome, Italy.
| | - Aldo Di Blasi
- Ospedale San Giovanni Evangelista, Tivoli, Rome, Italy
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15
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Tafuri A, Panunzio A, De Carlo F, Luperto E, Di Cosmo F, Cavaliere A, Rizzo M, Tian Z, Shakir A, De Mitri R, Porcaro AB, Cerruto MA, Antonelli A, Cormio L, Carrieri G, Karakiewicz PI, Abreu AL, Pagliarulo V. Transperineal Laser Ablation for Benign Prostatic Enlargement: A Systematic Review and Pooled Analysis of Pilot Studies. J Clin Med 2023; 12:jcm12051860. [PMID: 36902647 PMCID: PMC10003190 DOI: 10.3390/jcm12051860] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
Transperineal laser ablation (TPLA) of the prostate is a new minimally invasive treatment option in men with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE). The aim of this systematic review was to investigate the efficacy and safety of TPLA in the management of BPE. The primary outcomes were the improvement in urodynamic parameters (maximum urinary flow (Qmax) and postvoiding residue (PVR)) and LUTS relief, assessed using the IPSS questionnaire. The secondary outcomes were the preservation of sexual and ejaculatory functions, assessed with the IEEF-5 and MSHQ-EjD questionnaires, respectively, and rates of postoperative complications. We reviewed the literature for prospective or retrospective studies evaluating the use of TPLA in the treatment of BPE. A comprehensive search in PubMed, Scopus, Web of Science, and ClinicalTrials.gov was performed for English language articles published between January 2000 and June 2022. Pooled analysis of the included studies with available follow-up data for the outcomes of interest was additionally performed. After screening 49 records, six full-text manuscripts were identified, including two retrospective and four prospective non-comparative studies. Overall, 297 patients were included. All the studies independently reported a statistically significant improvement, from baseline, in Qmax, PVR, and IPSS score at each timepoint. Three studies additionally demonstrated that TPLA did not affect sexual function, reporting no change in the IEEF-5 score, and a statistically significant improvement in MSHQ-EjD score at each timepoint. Low rates of complications were recorded in all the included studies. Pooled analysis showed a clinically meaningful improvement in both micturition and sexual outcomes mean values at 1, 3, 6, and 12 months of follow-up, compared with baseline. Transperineal laser ablation of the prostate for the treatment of BPE showed interesting results in pilot studies. However, higher level and comparative studies are needed to confirm its efficacy in relieving obstructive symptoms and preserving sexual function.
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Affiliation(s)
- Alessandro Tafuri
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
- Correspondence: or ; Tel.: +39-0832661324; Fax: +39-0832661382
| | - Andrea Panunzio
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, 37126 Verona, Italy
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
| | | | - Elia Luperto
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | | | - Arturo Cavaliere
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | - Mino Rizzo
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
| | - Aliasger Shakir
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Rita De Mitri
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | - Antonio Benito Porcaro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, 37126 Verona, Italy
| | - Maria Angela Cerruto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, 37126 Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, 37126 Verona, Italy
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, University of Foggia, 71122 Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, 71122 Foggia, Italy
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
| | - Andre Luis Abreu
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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16
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Sessa F, Polverino P, Siena G, Bisegna C, Lo Re M, Spatafora P, Pecoraro A, Rivetti A, Moscardi L, Saladino M, Cocci A, Gacci M, Li Marzi V, Carini M, Minervini A, Campi R, Serni S. Transperineal Laser Ablation of the Prostate (TPLA) for Lower Urinary Tract Symptoms Due to Benign Prostatic Obstruction. J Clin Med 2023; 12:jcm12030793. [PMID: 36769454 PMCID: PMC9918261 DOI: 10.3390/jcm12030793] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
We aimed to review the current evidence on surgical and functional outcomes of Transperineal Laser Ablation for LUTS due to BPH. A comprehensive review of the English-language literature was performed using the MEDLINE and Web of Science databases until 1 August 2022, aiming to select studies evaluating TPLA for the treatment of LUTS due to BPH. Additional records were found from Google Scholar. Data were extracted and summarized in Tables. An appropriate form was used for qualitative data synthesis. Seven studies were included in the review, with all being single arm, non-comparative studies. In all studies, functional outcomes were evaluated with uroflowmetry parameters and validated questionnaires, showing a promising effectiveness at short- and mid-term follow-up. There is a lack of standardized pathways for preoperative assessment of patients suitable for TPLA, and even the technique itself has been reported with a few nuances. A good safety profile has been reported by all the authors. Although promising results have been reported by different groups, selection criteria for TPLA and few technical nuances regarding the procedure were found to be heterogeneous across the published series that should be standardized in the future. Further research is needed to confirm these findings.
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Affiliation(s)
- Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy
- Correspondence: ; Tel.: +39-055-275-8020 or +39-055-794-9209; Fax: +39-055-275-8014
| | - Paolo Polverino
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Giampaolo Siena
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Claudio Bisegna
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Mattia Lo Re
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Anna Rivetti
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Luisa Moscardi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Marco Saladino
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Andrea Cocci
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Marco Carini
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy
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17
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Tzelves L, Nagasubramanian S, Pinitas A, Juliebø-Jones P, Madaan S, Sienna G, Somani B. Transperineal laser ablation as a new minimally invasive surgical therapy for benign prostatic hyperplasia: a systematic review of existing literature. Ther Adv Urol 2023; 15:17562872231198634. [PMID: 37745187 PMCID: PMC10515526 DOI: 10.1177/17562872231198634] [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] [Received: 05/11/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Transperineal laser ablation (TPLA) of the prostate is a new, minimally invasive technique for benign prostatic hyperplasia (BPH) with promising effectiveness and safety outcomes. This systematic review aims to provide an update of existing literature. Methods A literature review was performed in Pubmed/MEDLINE, Embase, Cochrane Library, and clinicaltrials.gov from January 2000 up to April 2023. Data extraction and risk of bias were performed independently by three authors. Results A total of 11 studies were included, among which 9 were observational, 1 randomized controlled trial, 1 animal study, while 2 of them were comparative (1 with prostatic artery embolization and 1 with transurethral resection of the prostate). Functional outcomes were improved in the majority of studies both for objective (maximum flow rate and post-void residual) and subjective outcomes (improvement of International Prostate Symptom Score and quality of life). Complication rates ranged between 1.9% and 2.3% for hematuria, 3.7% and 36.3% for dysuria, 1.9% and 19% for acute urinary retention, 0.6% and 9.1% for orchitis/urinary tract infections, and 0.6% and 4.8% for prostatic abscess formation. Regarding sexual function, >95% of patients retained their ejaculation while erectile function was maintained or improved. Conclusion TPLA of the prostate is an innovative, minimally invasive technique for managing patients with BPH. Existing studies indicate an effective technique in reducing International Prostate Symptom Score and quality of life scores, post-void residual reduction, and increase in Qmax, albeit the measured improvements in terms of Qmax are not equal to transurethral resection of the prostate. Although sexual function is maintained, the mean catheterization time is 7 days, and no long-term data are available for most patients.
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Affiliation(s)
- Lazaros Tzelves
- Department of Urology, University College London Hospitals, London, UK
| | | | - Alexandros Pinitas
- Department of Urology, General Hospital of Athens ‘Gennimatas’, Athens, Greece
| | | | - Sanjeev Madaan
- Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Giampaolo Sienna
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence, Italy
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK
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