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Feasibility, safety, and efficacy of ultrasound-guided transperineal laser ablation for the treatment of benign prostatic hyperplasia: a single institutional experience

Abstract

Purpose

To evaluate the feasibility, safety, and efficacy of ultrasound-guided transperineal laser ablation (TPLA) as a new minimally invasive surgical therapy (MIST) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

Materials and methods

Under local anesthesia and conscious sedation up to two laser fibers for each prostatic lobe were inserted under US-guidance by a percutaneous approach. TPLA was performed using a continuous wave diode laser (SoracteLite-EchoLaserX4) able to generate a light-induced thermal heating and subsequent coagulative necrosis of the prostatic tissue. Patients were evaluated at 3, 6, and 12 months after TPLA.

Results

Twenty-two consecutive patients were prospectively enrolled (median age 61.9 years). All procedures were well tolerated and no procedural complications were recorded. Median catheterization time was 7 days, while the median hospitalization time was 1 day. Three out of twenty-two patients (13.6%) experienced acute urinary retention and two (9.1%) of them urinary tract infection requiring major antibiotic treatment. At 3, 6, and 12 months, median prostate volume significantly decreased by a − 21.3%, − 29%, and − 41%, respectively. At the same time point, median IPSS was 8 (− 63.6%), 5 (− 74%), and 6 (− 75%), while median QoL score was 1 in all the scheduled timepoints of follow-up. The median postoperative Qmax at 3, 6, and 12 months improved by + 57.8%, + 98%, and + 115.8%, respectively. Ejaculatory function was preserved in 21 out of 22 patients (95.5%).

Conclusions

TPLA of the prostate appears to be a promising MIST for BPH. Long-term results and comparative studies against standard treatments are warranted before implementations of this technique in the urologist’s armamentarium.

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Availability of data and material

All data are available if request.

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Funding

No funds are requested.

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Affiliations

Authors

Contributions

NF data collection and management, data analysis, and manuscript writing/editing. AS protocol/project development and patients enrollment. PC protocol/project development and patients enrollment. PD data collection and management and video editing. RC data collection and management and manuscript revision. PPA data collection and management and manuscript revision. ML protocol/project development. RH protocol/project development and patients enrollment. NMB protocol/project development and patients enrollment. GFG conceptualization and protocol/project development. GL conceptualization, protocol/project development, and review of the manuscript.

Corresponding author

Correspondence to Nicola Frego.

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The authors have no relevant financial or non-financial interests to disclose.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study. Patients signed informed consent regarding publishing their data and photographs.

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Frego, N., Saita, A., Casale, P. et al. Feasibility, safety, and efficacy of ultrasound-guided transperineal laser ablation for the treatment of benign prostatic hyperplasia: a single institutional experience. World J Urol 39, 3867–3873 (2021). https://doi.org/10.1007/s00345-021-03685-7

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Keywords

  • BPH
  • LUTS
  • MISTs
  • TPLA