Mid-term results of water vapor thermal therapy in patients with lower urinary tract symptoms related to benign prostatic hyperplasia

To evaluate the reliability of transperineal interstitial laser ablation of the prostate (TPLA) in preserving antegrade ejaculation compared to transurethral resection of the prostate (TURP). Patients and MethodsIn this single-centre, prospective, randomized, open-label study, consecutive patients with indication for surgical treatment for benign prostatic obstruction (BPO) were enrolled between January 2020 and September 2021 (NCT04781049). Patients were randomized to one of two treatment arms: Group A: TPLA (experimental group) and Group B: TURP (reference standard group). The primary endpoint was change in ejaculatory function (assessed by the Male Sexual Health Questionnaire -Ejaculatory function domain [EJ-MSHQ]) at 1 month after surgery. Secondary endpoints included comparison of visual analogue scale (VAS) scores, changes in sexual function (assessed using the five-item International Index of Erectile Function [IIEF-5]), change in International Prostate Symptom Score [IPSS], change in quality of life score, and maximum urinary flow rate [Q max ] improvement at 1-6 months, as appropriate. ResultsFifty-one patients (26 TPLA vs 25 TURP) were analysed. No differences in the perception of pain assessed by VAS and no differences in IIEF-5 score were found between the groups. The distribution of ejaculatory function assessed by the EJ-MSHQ remained unmodified after TPLA (P = 0.2), while a median 30% decrease in EJ-MSHQ score was observed after TURP (P = 0.01). Absence of antegrade ejaculation was reported in one patient in the TPLA group (vs 18 patients in the TURP group). A statistically significant difference between the treatment groups was found in terms of postoperative Q max .3] mL/s vs 26.0 [interquartile range 22.0-48.0] mL/s; P < 0.001). Both treatments significantly improved Q max , with a mean 23.9 mL/s improvement after TURP (95% confidence interval [CI] 17.1-30.7) vs 6.0 mL/s after TPLA (95% CI 5.0-7.0), and IPSS, with a mean decrease of 11.6 (95% CI 9.7-13.5) vs 5.8 after TPLA (95% CI.2-9.6) with respect to baseline. ConclusionIn our study, TPLA preserved ejaculatory function in 96% of cases in addition to providing significant relief from BPO.

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“…Similarly, the more recent study by Ghahhari et al. reported an improvement in Q max of 7 mL/s at 6 months after Rezūm [24].…”

Section: Discussionmentioning

confidence: 79%

“…The Q max was statistically significantly improved with respect to its baseline value at 6-month evaluation after TPLA, achieving a median (IQR) value of 15. [24].…”

Section: Discussionmentioning

confidence: 99%

Ejaculatory function following transperineal laser ablation vs TURP for benign prostatic obstruction: a randomized trial

et al. 2023

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Predictors of Symptomatic Relief in WVTT for Prostatic Hyperplasia: 36-Month Prospective Study

Arroyave,

Larenas,

Massouh

et al. 2024

Preprint

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Purpose Existing literature lacks an analysis of factors predicting the achievement of minimum clinically important differences (MCID) after water vapor thermal therapy (WVTT) for prostatic hyperplasia. This study aims to identify these predictors over a 36-month post-WVTT period. Methods This prospective single surgeon case series assessed male patients receiving WVTT. Eligibility criteria included being at least 45 years old, having an estimated prostate volume (EPV) of 30–80 cc, an International Prostate Symptom Score (IPSS) of 12 points or more, and a maximum urinary flow rate (Qmax) under 16 mL/sec. MCID, representing the smallest symptomatic improvement perceived by patients, was calculated using the distribution-based method, considering half a standard deviation of baseline IPSS scores. Correlation and linear regression analyses assessed MCID attainment. Multivariate logistic regression evaluated MCID achievement, considering multicollinearity, heteroskedasticity, and normality. Results Of 206 men with a median 29.1-month follow-up (Range: 24–36), 13.6% didn't achieve MCID for IPSS, and 7.2% for QoL scores. Significant hindrances to MCID attainment for IPSS were a large median lobe (> 10mm protrusion) (OR = 3.01, 95% CI: 2.3–3.72), increased median lobe treatments (OR = 1.73, 95% CI: 1.23–2.35), and high preoperative irritative IPSS scores (OR = 1.25, 95% CI: 1.13–1.38). Factors for QoL MCID non-achievement included age over 75 (OR = 1.25, 95% CI: 1.13–1.38), a large median lobe (OR = 1.87, 95% CI: 1.62–2.01), and EPV over 60cc (OR = 1.55, 95% CI: 1.16–1.97). A 6.3% surgical re-intervention rate was noted. Conclusions The characteristics of the median lobe as well as the severity of lower urinary tract symptoms are crucial for treatment success. These should be integral to preoperative assessments and patient discussions on treatment options.

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Mid-term results of water vapor thermal therapy in patients with lower urinary tract symptoms related to benign prostatic hyperplasia

Cited by 2 publications

References 25 publications

Ejaculatory function following transperineal laser ablation vs TURP for benign prostatic obstruction: a randomized trial

Ejaculatory function following transperineal laser ablation vs TURP for benign prostatic obstruction: a randomized trial

Predictors of Symptomatic Relief in WVTT for Prostatic Hyperplasia: 36-Month Prospective Study

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