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

Abstract

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.

Transperineal laser ablation as a new minimally invasive surgical therapy for benign prostatic hyperplasia: a systematic review of existing literature

“…15 Similarly, all patients retained erectile function and ejaculation in the study by Manenti et al, 17 with a mean score of ejaculatory function, as assessed by the Male Sexual Questionnaire -Erectile Dysfunction (MSHQ-EiD) questionnaire, showing improvement. Sessa et al 20 reported preserved ejaculation in all patients and improvement in 15-29%, while erections were stable or even showed some improvement (+2-4%). Finally, Bertolo et al 10 in their RCT showed that 96% of patients who underwent TPLA preserved their ejaculation.…”

“…After excluding 74 records (65 due to irrelevant subjects, 3 conference abstracts, and 6 protocols with no published outcomes), 25 full texts were screened for eligibility. Finally, after excluding 3 reviews and 11 studies not on BPH or transperineal route of therapy, 11 studies were deemed eligible for inclusion: 1 RCT, 10 1 animal study, 11 and 9 observational studies, [12][13][14][15][16][17][18][19][20] from which one was comparative. 12 Since only two comparative studies were found, one of which was an RCT and they compared TPLA with either PAE or TURP, no meta-analysis was performed.…”

“…13 The energy setting was 1800 J per fiber and illumination at a fixed power of 3 W, 13,15,18,19 or 4.5-5 W reduced to 3-3.5 W after 1-2 min. 16,17,20 Details of the procedure: The initial planning is conducted on the biplanar TRUS, to ensure adequate margins of safety. The ellipsoid area of coagulative necrosis extends to 22.5 mm longitudinally (of which two-thirds are localized beyond the tip of the fiber and one-third behind the tip) and 16 mm transversely.…”

“…In three studies, no complications were recorded. 13,19,20 Clavien-Dindo grade I complications were most commonly transient hematuria and dysuria, while acute urinary retention requiring re-catheterization and urinary tract infections/ orchitis were the most commonly reported grade II complications. A prostatic abscess requiring drainage and prolonged course of antibiotics was the only grade III complication reported.…”

“…Six studies evaluated erectile function and ejaculation postoperatively. 10,[15][16][17][18]20 Pacella et al 18 reported a loss of ejaculation in 1.2% of patients, while de Rienzo et al 16 reported no change in the IIEF questionnaire, while ejaculation returned to baseline after 3-6 months. Frego et al 15 showed that ejaculation was preserved in 95.6% of patients, while no IIEF change was noticed at 12 months of follow-up, although only 45.5% completed the questionnaire at this timepoint.…”