Abstract
BackgroundTransperineal laser ablation (TPLA) of the prostate is a novel, mini-invasive option for men with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH). Our aim was to assess the impact of ultrasound-guided TPLA regarding urodynamic improvement and sexual function, monitoring clinical data, postprocedural complications and imaging findings at 3-T multiparametric magnetic resonance imaging.MethodsForty-four patients aged ≥ 50 affected with moderate to severe LUTS (International Prostate Symptoms score ≥ 12) due to benign prostatic obstruction and refractoriness, intolerance or poor compliance to medical therapies underwent US-guided TPLA between May 2018 and February 2020. Clinical measurements included PSA, uroflowmetry, sexual function assessment (using the International Index of Erectile Function and Male Sexual Health Questionnaire-Ejaculatory Dysfunction short form) and quality of life questionnaire. Adverse events were evaluated using the Clavien-Dindo scale. Volume changes were measured by MRI and automatic segmentation software during 1-year follow-up. Registration: NCT04044573 – May 5th, 2018, https://www.clinicaltrials.govResultsMRI assessed the changes over time with a 53% mean reduction of adenoma volume and 71% of the ablated area, associated with clinical and functional improvement and resolution of LUTS in all cases. Five of 44 patients (11.3%) had urinary blockage due to clots and required re-catheterisation for 2 weeks. The overall adverse event rate was 7%.ConclusionUS-guided TPLA performed as a safe, manageable and effective treatment for LUTS. It could be considered an alternative effective mini-invasive procedure to standard treatments for BPH in the outpatient setting.
Highlights
Transperineal laser ablation (TPLA) of the prostate is a novel, mini-invasive option for men with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH)
TURP is still considered the cornerstone of LUTS/Benign prostatic obstruction (BPO) minimally invasive treatment in men with a prostate size of 30–80 mL [5]; it is associated with the prevalence of important complications such as retrograde ejaculation, in more than 30% of cases [6,7,8]
This study aims to evaluate ultrasound
Summary
Transperineal laser ablation (TPLA) of the prostate is a novel, mini-invasive option for men with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH). Benign prostate enlargement is a common disease amongst elderly men It may cause functional obstruction of the bladder outlet (BPO), which is the major cause of lower urinary tract symptoms (LUTS) [1, 2]. TURP is still considered the cornerstone of LUTS/BPO minimally invasive treatment in men with a prostate size of 30–80 mL [5]; it is associated with the prevalence of important complications such as retrograde ejaculation, in more than 30% of cases [6,7,8]. HoLEP causes retrograde ejaculation in 70% of cases, whereas this complication has been reported to be 63% for photovaporisation of the prostate using Nd:YAG laser [9] These procedures have been proposed as an alternative to TURP in order to reduce invasiveness and hospitalisation time
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