3-T MRI and clinical validation of ultrasound-guided transperineal laser ablation of benign prostatic hyperplasia

Manenti, Guglielmo; Perretta, Tommaso; Calcagni, Antonello; Ferrari, Donatella; Ryan, Colleen P.; Fraioli, Federico; Meucci, Rosaria; Malizia, A.; Iacovelli, Valerio; Agrò, Enrico Finazzi; Floris, Roberto

doi:10.1186/s41747-021-00239-9

Cited by 21 publications

(80 citation statements)

References 35 publications

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“…A similar study by Frego et al in a cohort of patients with slightly higher prostate volumes and including three-lobes prostates confirmed the promising role of TPLA for carefully selected patients with LUTS due to BPO (9). The favorable outcomes obtained by TPLA were reported by similar previous experiences (10)(11)(12). While some surgeons did not consider the presence of a prostatic median lobe as a formal contraindication to TPLA (8,9,11,12), in our cohort we selected only patients with BPO without a median lobe, mainly due to learning curve issues.…”

Section: Discussionsupporting

confidence: 74%

“…Of note, none of the available systematic reviews in this field included data from TPLA, though different authors have already described its feasibility and safety in real-life settings (7)(8)(9)(10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

“…Further research is needed to assess the feasibility, safety and outcomes of TPLA in this specific patient cohort. Another debated theme is also the potential contraindication for TPLA represented by patients with BPO and an indwelling catheter, which was considered an exclusion criterion by some authors (8,10). As reported above, we included 4 patients with indwelling catheter in our analysis, obtaining resumption of micturition after treatment in two (50%) of them.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the clinical improvements reported with this technique might theoretically be still inferior to those obtained by recommended techniques such as TURP and enucleative procedures, especially from a pure urodynamic standpoint. On the other side, TPLA has several potential advantages over traditional techniques, including avoidance of general anesthesia, performance in an outpatient setting, the low risk of intra-and perioperative adverse events and the virtually absent risk of ejaculatory disfunction (3,(7)(8)(9)(10)(11)(12). In this regard, the right placement of the applicators and the use of the planning software of Echolaser Smart Interface during TPLA is crucial to maintain a safe distance from the bladder neck and the urethral lumen (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

“…In this scenario, transperineal interstitial laser ablation of the prostate (TPLA) represents a novel option for minimally invasive treatment of BPO; although it is still not recommended by the latest European Association of Urology (EAU) Guidelines, it has shown promising results in terms of feasibility and safety (7)(8)(9)(10)(11)(12). Nevertheless, data in literature are still scarce regarding the best indications, functional outcomes and patient-reported outcomes after TPLA.…”

Section: Introductionmentioning

confidence: 99%

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Transperineal laser ablation of the prostate with EchoLaser™ system: perioperative and short-term functional and sexual outcomes

et al. 2022

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ObjectiveTo date, several ultra-minimally-invasive surgical techniques are available for the treatment of male LUTS due to benign prostatic obstruction (BPO). Herein we report our preliminary experience with SoracteLite™ TPLA for the treatment of carefully selected patients with LUTS due to BPO.MethodsData from all consecutive patients undergoing TPLA at our institution between April 2021 and February 2022 were prospectively collected in a specific database. Data regarding functional and sexual outcomes evaluated by validated questionnaires and uroflowmetry were analyzed. All the procedure were performed in an outpatient setting, under local anesthesia and conscious sedation, using EchoLaser device, a multisource diode laser generator.ResultsOverall, 38 patients underwent TPLA at our institution during the study period. The median prostate volume was 46 ml (IQR 38-71). The median time to complete the procedure was 31 min (IQR 28-37). All patients but one were discharged within 8 hours of hospital stay. No perioperative Clavien-Dindo grade ≥2 complications were recorded. Median improvement in Qmax was 17%, 24% and 32% at 1 month, 3 months and last follow-up after surgery; as a result, the median postoperative IPSS at 1 month, 3 months and at last follow-up decreased by -14%, -36% and -35%, respectively. All patients preserved ejaculatory and sexual function. Two patients (5%), catheter carriers before the procedure, experienced acute urinary retention after TPLA treatment and required replacement of an indwelling catheter.ConclusionsTPLA can be a feasible, safe and effective ultra-minimally-invasive procedure for carefully selected patients with LUTS due to BPO.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transperineal laser ablation of the prostate with EchoLaser™ system: perioperative and short-term functional and sexual outcomes

et al. 2022

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Transperineal laser ablation as treatment for benign prostatic obstruction: Safety, feasibility and functional outcomes—A pilot study

van Kollenburg,

van Riel,

Bloemen

et al. 2023

BJUI Compass

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BackgroundStandard 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.ObjectivesThe 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.MethodsThis 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).ResultsTwenty 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.ConclusionsTPLA 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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Ultrasound-guided SoracteLite™ transperineal laser ablation (TPLA) of the prostate for the treatment of symptomatic benign prostatic hyperplasia (BPH): a prospective single-center experience

Laganà¹,

Lascio²,

Blasi³

et al. 2023

World J Urol

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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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3-T MRI and clinical validation of ultrasound-guided transperineal laser ablation of benign prostatic hyperplasia

Cited by 21 publications

References 35 publications

Transperineal laser ablation of the prostate with EchoLaser™ system: perioperative and short-term functional and sexual outcomes

Transperineal laser ablation of the prostate with EchoLaser™ system: perioperative and short-term functional and sexual outcomes

Transperineal laser ablation as treatment for benign prostatic obstruction: Safety, feasibility and functional outcomes—A pilot study

Ultrasound-guided SoracteLite™ transperineal laser ablation (TPLA) of the prostate for the treatment of symptomatic benign prostatic hyperplasia (BPH): a prospective single-center experience

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