En-bloc endoscopic enucleation of the prostate: a systematic review of the literature

Tuccio, Agostino; Sessa, Francesco; Campi, Riccardo; Grosso, Antonio Andrea; Viola, Lorenzo; Muto, Gianluca; Scoffone, Cesare Marco; Cracco, Cecilia Maria; Sancha, Fernando Gómez; Misraï, Vincent; Muto, Giovanni; Mari, Andrea; Maida, Fabrizio Di; Tellini, Riccardo; Figueiredo, Felipe; Carini, Marco; Oriti, Rino; Amparore, Daniele; Fiori, Cristian; Porpiglia, Francesco

doi:10.23736/s0393-2249.20.03706-6

Cited by 31 publications

(13 citation statements)

References 38 publications

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“…In the last decades, various other surgical options have been proposed in clinical practice with the aim to minimize the risk of surgical complications in comparison with standard techniques, while producing a symptom's relief higher than oral medications. Endoscopic techniques such as laser enucleation, photo-vaporization, and water ablation of the prostate have demonstrated great efficacy, but have been shown to have not negligible rates of complications [9][10][11][12][13][14][15][16]. On the other hand, MIS does not seem to be burdened by a significant rate of AEs compared to TURP [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Functional Results after First- and Second-Generation Temporary Implantable Nitinol Device (TIND) for BPH: A Narrative Review of the Literature

Cillis

Volpi

Checcucci

et al. 2022

Curr Bladder Dysfunct Rep

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Purpose of review In the last decades, new promising technologies for the treatment of BPH-related lower urinary tract symptoms (LUTS) have been widely experienced in clinical practice, with the aim of offering fewer complications but similar functional outcomes compared with the gold standard transurethral resection of the prostate (TURP). Among these so-called minimally invasive approaches, transurethral implantation of first- and second-generation temporary implantable nitinol device (TIND and iTIND, respectively) (Medi-Tate; Medi-Tate Ltd., Or Akiva, Israel) has been included by the European Association of Urology (EAU) Guidelines as one of the available alternative treatments to TURP. In the present paper, we conducted a systematic review of the current literature on TIND and iTIND implantation focusing on functional outcomes. Medline, Embase, and Cochrane databases were queried for relevant Literature in May 2021. Recent findings Data regarding the use of temporary implantable nitinol device for BPH are still very limited, with only seven studies currently available in Literature. All the studies report that both TIND and iTIND procedures are safe, effective, and well tolerated. Moreover, such treatments seem to not affect patient’s sexual and ejaculatory functions. Summary Current clinical evidence suggests that temporary implantation of first- and second-generation temporary implantable nitinol devices are valid options for the minimally invasive surgical treatment of BPH-related LUTS. Further studies are required in order to confirm the functional results, especially over a long-term follow up.

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Section: Introductionmentioning

confidence: 99%

Functional Results after First- and Second-Generation Temporary Implantable Nitinol Device (TIND) for BPH: A Narrative Review of the Literature

Cillis

Volpi

Checcucci

et al. 2022

Curr Bladder Dysfunct Rep

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“…With the emergence of various intracavitary minimally invasive devices, new technologies are being applied to the medical field, such as transurethral enucleation of the prostate (TUEP), which including plasma kinetic enucleation of the prostate (PKEP), holmium laser enucleation of prostate (HoLEP), thulium laser enucleation of the prostate (ThuleP) and some other laser based methods (22). Lasers show better haemostatic effects and cause less bleeding during operations (23)(24)(25)(26).…”

Section: Introductionmentioning

confidence: 99%

“…Although these new techniques might offer sufficient Abbreviations: BPH, benign prostatic hyperplasia; TPLA, transperineal percutaneous laser ablation; TURP, transurethral resection of the prostate; RCT, randomised controlled trial; RDC, remote data capture; LUTS, lower urinary tract symptoms; IPSS, International Prostate Symptom Score; IWRS, Interactive Web Response System; QoL, quality of life; EQ-5D, European five-dimensional health scale; VAS, visual analogue score; ECG, electrocardiograph; PSA, prostate specific antigen; TRUS, transrectal ultrasonography; MRI, magnetic resonance imaging; AE, adverse event; SAE, serious adverse event; IIEF-5, International Index of Erectile Function-5; MSHQ-EjD, Male Sexual Health Questionnaire-Ejaculatory Dysfunction; eCRF, electronic case report form. efficacy and lower risk of complications over standard bipolar-TURP (27,28), However, the levels of evidence are too low and follow-up still too short to offer solid recommendations, and larger comparative studies are needed to evaluate the ultimate impact of the en-bloc approach on postoperative outcomes (22,29). And since the surgical approach are transurethral avoiding injury is challenging, and haematuria and urethral stricture may occur after the operation (30)(31)(32)(33).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, lasers are non-conductive; thus, they can be applied in patients with heart pacemakers and other electric implants. Although these new techniques might offer sufficient efficacy and lower risk of complications over standard bipolar-TURP ( 27 , 28 ), However, the levels of evidence are too low and follow-up still too short to offer solid recommendations, and larger comparative studies are needed to evaluate the ultimate impact of the en-bloc approach on postoperative outcomes ( 22 , 29 ). And since the surgical approach are transurethral avoiding injury is challenging, and haematuria and urethral stricture may occur after the operation ( 30 – 33 ).…”

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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“…Nowadays, the most relevant surgical options for benign prostate obstruction (BPO) include simple prostatectomy, trans-urethral resection of the prostate (TURP), laser enucleation of the prostate (i.e., HoLEP/ThuLEP, etc.) , and Greenlight laser vaporization of the prostate (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience

Sessa

Campi

Granieri³

et al. 2021

Front. Surg.

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Objectives: To evaluate the feasibility and safety of a proctored step-by-step training program for GreenLight laser anatomic photovaporization (aPVP) of the prostate.Methods: Data from patients undergoing aPVP between January 2019 and December 2020 operated by a single surgeon following a dedicated step-by-step proctored program were prospectively collected. The procedure was divided into five modular steps of increasing complexity. Preoperative patients' data as well as total operative time, energy delivered on the prostate and postoperative data, were recorded. Then, we assessed how the overall amount of energy delivered and the operative times varied during the training program. Surgical steps were analyzed by cumulative summation. Univariable and multivariable regression models were built to assess the predictors of the amount of energy delivered on the prostate.Results: Sixty consecutive patients were included in the analysis. Median prostate volume was 56.5 mL. The training program was succesfully completed with no intraoperative or meaningful post-operative complications. The energy delivered reached the plateau after the 40th case. At multivariable analysis, increasing surgeon experience was associated with lower amounts of energy delivered as well as lower operative times.Conclusions: A step-by-step aPVP training program can be safely performed by surgeons with prior endoscopic experience if mentored by a skilled proctor. Considering the energy delivered as an efficacy surrogate metrics (given its potential impact on persistent postoperative LUTS), 40 cases are needed to reach a plateau for aPVP proficiency. Further studies are needed to assess the safety of our step-by-step training modular program in other clinical contexts.

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En-bloc endoscopic enucleation of the prostate: a systematic review of the literature

Cited by 31 publications

References 38 publications

Functional Results after First- and Second-Generation Temporary Implantable Nitinol Device (TIND) for BPH: A Narrative Review of the Literature

Functional Results after First- and Second-Generation Temporary Implantable Nitinol Device (TIND) for BPH: A Narrative Review of the Literature

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

Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience

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