Ultrasound-guided transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: a new minimally invasive interventional therapy

Cai, Huai-Jie; Fang, Jianhua; Kong, Fanlei; Xu, Chenke; Chen, Chuang-Hua; Wang, Wei; Huang, Bin

doi:10.1177/02841851211003289

Cited by 21 publications

(59 citation statements)

References 23 publications

(16 reference statements)

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“…Using very thin applicators and high-precision energy delivery, percutaneous laser ablation has been demonstrated to be safe and effective ( 45 – 48 ). Several preliminary studies including short-term follow-up proved its feasibility, Pacella revealed IPSS improved from 22.5 ± 5.1 to 7.7 ± 3.3 at 6 months and 7.0 ± 2.9 at 12 months, Cai HJ proved ultrasound guided TPLA effective and safe with the QoL improved from 4.9 ± 1.7 to 2.3 ± 1.3 and the Qmax improved from 8.5 ± 3.0 to 15.2 ± 4.8 mL/s at 6 months after the procedure ( 37 , 41 ). However, no comparison with patients treated with other techniques has been performed, especially TURP, the most widely used surgical method and “gold standard” for BPH patients.…”

Section: Discussionmentioning

confidence: 89%

“…Can laser treatment of prostate guided by TRUS achieve the minimally invasive treatment of BPH using a percutaneous transperineal approach? Researchers have verified transperineal percutaneous laser ablation (TPLA) a feasible and safe method (35)(36)(37)(38)(39)(40). Pacella CM conducted a single arm trial, performed the analysis on 160 patients with 6 months follow and 83 patients with 12 months after TPLA (41), and de Rienzo G conducted TPLA for 21 patients, verified the significant advantage in Qmax, IPSS, and peculiar ability to preserve ejaculation (38).…”

Section: Introductionmentioning

confidence: 99%

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The Design and Rationale of a Multicentre Randomised Controlled Trial Comparing Transperineal Percutaneous Laser Ablation With Transurethral Resection of the Prostate for Treating Benign Prostatic Hyperplasia

Zhang

Guo

et al. 2021

Front. Surg.

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Background: Transurethral resection of the prostate (TURP) is regarded as the “gold standard” for the treatment of benign prostatic hyperplasia (BPH) in elderly men. However, ~15% of patients who had undergone TURP had intraoperative and postoperative complications, such as bleeding, urinary incontinence and urethral stricture. Transperineal percutaneous laser ablation (TPLA) is a method that places the optical fibre directly into the prostate with the guidance of ultrasound imaging, and the percutaneous transperineal approach is performed distal to the urethra and rectum to protect these structures and reduce urethral or postoperative infection. Several studies on TPLA for BPH treatment have been reported recently; however, high-quality randomised controlled trial (RCT) to evaluate its efficacy, safety, and long-term follow up remain absent.Methods: This study is a multicentre, open-label RCT to assess the efficacy and safety of TPLA vs. TURP to treat BPH. We hypothesise that the TPLA has non-inferior efficacy to TURP in the International Prostate Symptom Score (IPSS) at 3 months changing from the baseline and lower incidence of post-surgery complications. One hundred and fourteen patients with BPH will be recruited at 19 sites and randomly assigned at 1:1 to TPLA or TURP groups. The patients will be followed up at 1, 3, 6, 12, and 24 months after the procedure.Discussion: The study will be the first multicentre clinical trial including 16 participating centres in China, Italy, Switzerland, and Poland with relatively large sample size 114. By comprehensively compare the safety and efficacy of TPLA with TURP in patients with BPH, especially concerning the improvement of lower urinary tract symptoms (LUTS) and complication incidence, the study will help to illustrate the clinical value of TPLA and provide a beneficial alternative treatment for BPH patients.Clinical Trial Registration: The study has been registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn), identifier [ChiCTR1900022739].

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

The Design and Rationale of a Multicentre Randomised Controlled Trial Comparing Transperineal Percutaneous Laser Ablation With Transurethral Resection of the Prostate for Treating Benign Prostatic Hyperplasia

Zhang

Guo

et al. 2021

Front. Surg.

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“…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%

“…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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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 transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: a new minimally invasive interventional therapy

Cited by 21 publications

References 23 publications

The Design and Rationale of a Multicentre Randomised Controlled Trial Comparing Transperineal Percutaneous Laser Ablation With Transurethral Resection of the Prostate for Treating Benign Prostatic Hyperplasia

The Design and Rationale of a Multicentre Randomised Controlled Trial Comparing Transperineal Percutaneous Laser Ablation With Transurethral Resection of the Prostate for Treating Benign Prostatic Hyperplasia

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

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