Transperineal interstitial laser ablation of the prostate, a novel option for minimally invasive treatment of benign prostatic obstruction

Rienzo, Gaetano De; Lorusso, A; Minafra, P.; Zingarelli, Marcello; Papapicco, Giuseppe; Lucarelli, Giuseppe; Battaglia, Michele; Ditonno, Pasquale

doi:10.1016/j.eururo.2020.08.018

Cited by 33 publications

(86 citation statements)

References 10 publications

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“…Moreover, the efficacy and safety of this skill were confirmed by the one-year follow-up. Rienzo et al (24) reported that TPLA not only promotes QoL and resolves symptoms of urinary tract obstruction, but also preserve erectile function and ejaculation function (based on the right control of the ablation scope during the operation, thus avoiding the ejaculatory duct, bladder neck, and perineal innervation), which is undoubtedly beneficial to middle-aged patients with BPH with desired fertility. After studying 20 patients and reviewing the literature, matters needing attention of this technique are summarized as follows:…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Background Although there are different treatments for benign prostate hyperplasia, their efficacy and safety differ. We are currently exploring a new minimally invasive interventional therapy for benign prostatic hyperplasia (BPH). Purpose To determine the feasibility, effectiveness, and safety of ultrasound-guided transperineal laser ablation (US-TPLA) for the treatment of BPH. Material and Methods Twenty patients with BPH (mean age = 73.9 ± 9.2 years) who underwent US-TPLA from June 2018 to January 2020 with a subsequent six-month follow-up were retrospectively reviewed. After local anesthesia, a 21-G trocar was inserted into the prostate tissue under ultrasound monitoring, followed by 1064 nm diode laser irradiation. Changes in international prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate volume, and complications were evaluated six months after surgery. Results All patients underwent the operation successfully without serious complications. After six months, the average IPSS improved from 22.7 ± 5.3 to 9.1 ± 3.2 ( P < 0.001), the QoL improved from 4.9 ± 1.7 to 2.3 ± 1.3 ( P < 0.001), the Qmax improved from 8.5 ± 3.0 to 15.2 ± 4.8 mL/s ( P < 0.001), the PVR increased from 78.7 ± 58.8 to 30.3 ± 34.2 ( P < 0.05), and the mean prostate volume ranged from 70.8 ± 23.8 to 54.7 ± 20.9 mL ( P < 0.05). Conclusion US-TPLA is safe and feasible for the treatment of BPH. An evaluation at the six-month follow-up is effective.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…The use of TRUS guidance with a biplane probe allows repositioning of applicators during the manoeuvre based on the physician experience, and the amount of energy is planned in advance according to the baseline volume of the prostatic lobes (35,38,49). The assessment of the extent of the coagulation zone after ablation with transrectal contrastenhanced ultrasonography is considered a very useful tool for early result assessment (50)(51)(52).…”

Section: Discussionmentioning

confidence: 99%

“…TPLA provides a new method of operation, but the indication is relatively narrow compared with TURP. Patients with bladder dysfuntion ( 38 ), rectal surgery history, an oversized prostate with a prominent medial lobe or BPH with cystolith would not be appropriate for TPLA. As a matter of fact, it's an supplementary option for BPH patients, instead of a replacement to other surgery method.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…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). However, high-quality RCTs, compared with TURP, the most widely used surgical method and "gold standard" for BPH patients, remained absent.…”

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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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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Transperineal interstitial laser ablation of the prostate, a novel option for minimally invasive treatment of benign prostatic obstruction

Cited by 33 publications

References 10 publications

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

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

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

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