New minimally invasive solutions for Benign Prostatic Obstruction (BPO) management: A position paper from the UrOP (Urologi Ospedalità Gestione Privata)

Submitted: October 19, 2023
Accepted: November 16, 2023
Published: December 20, 2023
Abstract Views: 688
PDF: 435
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

To the Editor, In recent years, alternative solutions have been proposed to obtain effective results comparable to TURP, which is currently considered the gold standard, and laser vapo-enucleation techniques (1, 2), but with the possibility of maintaining sexual functions. In recent years there has been a growing trend towards ejaculation preservation. Although the results of TURP (3), and most laser enucleation techniques are undoubted in the Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS) management, they often lack in the preservation of ejaculation. All the alternative recently proposed interventions (Rezum, AquaBeam, Urolift, TPLA, i-TIND, LEST) are procedures considered by some authors to be promising in both managing BPO and preserving sexual functions. However, all these methods are limited by a lack of long-term follow-up that would evaluate the efficacy over time, possible complications related to the method and the correct patient selection for a specific method. The aim of this letter is to summarize the available evidence and provide clinicians with practical recommendations on the use of the brand new minimally invasive techniques for the management of BPO. [...]

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Mostafa MM, Patil N, Khalil M, et al. Is Holmium Laser Enucleation of Prostate equally effective in management of benign prostatic hyperplasia patients with either voiding or storage lower urinary tract symptoms? A comparative study. Arch Ital Urol Androl 2022; 94:174-179. DOI: https://doi.org/10.4081/aiua.2022.2.174
EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam 2022. ISBN 978-94-92671-16-5.
Karaca Y, Sahinler EB, Karaca DI, Sinanoglu O. Analysis of transurethral resection of prostate videos on YouTubeTM: Educational quality assessment. Arch Ital Urol Androl 2023; 95:11404. DOI: https://doi.org/10.4081/aiua.2023.11404
Leonardi R. The LEST technique: Treatment of prostatic obstruction preserving antegrade ejaculation in patients with benign prostatic hyperplasia. Arch Ital Urol Androl 2019; 91:35-42. DOI: https://doi.org/10.4081/aiua.2019.1.35
Leonardi R. Preliminary results on selective light vaporization with the side-firing 980 nm diode laser in benign prostatic hyperplasia: an ejaculation sparing technique. Prostate Cancer Prostatic Dis 2009; 12:277-280. DOI: https://doi.org/10.1038/pcan.2009.5
Faber K, De Abreu ALC, Ramos P, et al. Image-Guided Robot-Assisted Prostate Ablation Using Water Jet Hydrodissection: Initial Study of a Novel Technology for Benign Prostatic Hyperplasia. J Endourol 2015; 29:63-69. DOI: https://doi.org/10.1089/end.2014.0304
Das AK, Han TM, Uhr A, Roehrborn CG. Benign prostatic hyperplasia: an update on minimally invasive therapy including Aquablation. Can J Urol 2020; 27:2-10
Gilling P, Barber N, Bidair M, et al. WATER: A Double-Blind, Randomized, Controlled Trial of Aquablation ® vs Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia. J Urol 2018; 199:1252-1261. DOI: https://doi.org/10.1016/j.juro.2017.12.065
Gilling P, Barber N, Bidair M, et al. Three-year outcomes after Aquablation therapy compared to TURP: results from a blinded randomized trial. Can J Urol 2020; 27:10072-10079. DOI: https://doi.org/10.1016/S2666-1683(20)32809-3
Misrai V, Rijo E, Zorn KC, et al. Waterjet Ablation Therapy for Treating Benign Prostatic Obstruction in Patients with Small- to Mediumsize Glands: 12-month Results of the First French Aquablation Clinical Registry. Eur Urol 2019; 76:667-675. DOI: https://doi.org/10.1016/j.eururo.2019.06.024
Kasivisvanathan V, Hussain M. Aquablation versus transurethral resection of the prostate: 1 year United States - cohort outcomes. Can J Urol 2018; 25:9317-9322.
Gilling P, Barber N, Bidair M, et al. Two-Year Outcomes After Aquablation Compared to TURP: Efficacy and Ejaculatory Improvements Sustained. Adv Ther 2019; 36:1326-1336. DOI: https://doi.org/10.1007/s12325-019-00952-3
Plante M, Gilling P, Barber N, et al. Symptom relief and anejaculation after aquablation or transurethral resection of the prostate: subgroup analysis from a blinded randomized trial. BJU Int 2019; 123:651-660. DOI: https://doi.org/10.1111/bju.14426
Nguyen D-D, Barber N, Bidair M, et al. WATER versus WATER II 2-Year Update: Comparing Aquablation Therapy for Benign Prostatic Hyperplasia in 30-80-cm3 and 80-150-cm3 Prostates. Eur Urol Open Sci 2021; 25:21-28. DOI: https://doi.org/10.1016/j.euros.2021.01.004
Desai M, Bidair M, Bhojani N, et al. Aquablation for benign prostatic hyperplasia in large prostates (80-150 cc): 2-year results. Can J Urol 2020; 27:10147-10153. DOI: https://doi.org/10.1111/bju.14703
Pimentel MA, Yassaie O, Gilling P. Urodynamic Outcomes After Aquablation. Urology 2019; 126:165-170. DOI: https://doi.org/10.1016/j.urology.2019.01.020
Bhojani N, Bidair M, Zorn KC, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology 2019; 129:1-7. DOI: https://doi.org/10.1016/j.urology.2019.04.029
MacRae C, Gilling P. How I do it: Aquablation of the prostate using the AQUABEAM system. Can J Urol 2016; 23:8590-8593.
Bilhim T, Betschart P, Lyatoshinsky P, et al. Minimally Invasive Therapies for Benign Prostatic Obstruction: A Review of Currently Available Techniques Including Prostatic Artery Embolization, Water Vapor Thermal Therapy, Prostatic Urethral Lift, Temporary Implantable Nitinol Device and Aquablation. Cardiovasc Intervent Radiol 2022; 45:415-424. DOI: https://doi.org/10.1007/s00270-021-03052-4
Whiting D, Ng KL, Barber N. Initial single centre experience of Aquablation of the prostate using the AquaBeam system with athermal haemostasis for the treatment of benign prostatic hyperplasia: 1-year outcomes. World J Urol 2021; 39:3019-3024. DOI: https://doi.org/10.1007/s00345-020-03534-z
Trama F, Lauro GD, Illiano E, et al. Ejaculation Sparing Thulium Laser Enucleation of the Prostate: An Observational Prospective Study. J Clin Med 2022; 11:6365. DOI: https://doi.org/10.3390/jcm11216365
Foster HE, Dahm P, Kohler TS, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2019. J Urol 2019; 202:592-598. DOI: https://doi.org/10.1097/JU.0000000000000319
Darson MF, Alexander EE, Schiffman ZJ, et al. Procedural techniques and multicenter postmarket experience using minimally invasive convective radiofrequency thermal therapy with Rezu¯m system for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Res Rep Urol Volume 2017; 9:159-168. DOI: https://doi.org/10.2147/RRU.S143679
Franco JVA, Jung JH, Imamura M, et al. Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis. BJU Int 2022; 130:142-156. DOI: https://doi.org/10.1111/bju.15653
McVary KT, Gange SN, Gittelman MC, et al. Erectile and Ejaculatory Function Preserved With Convective Water Vapor Energy Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Randomized Controlled Study. J Sex Med 2016; 13:924-933. DOI: https://doi.org/10.1016/j.jsxm.2016.03.372
Roehrborn CG, Gange SN, Gittelman MC, et al. Convective Thermal Therapy: Durable 2-Year Results of Randomized Controlled and Prospective Crossover Studies for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. J Urol 2017; 197:1507-1516. DOI: https://doi.org/10.1016/j.juro.2016.12.045
Kang TW, Jung JH, Hwang EC, Borofsky M, Kim MH, Dahm P. Convective radiofrequency water vapour thermal therapy for lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev. 2020; 3:CD013251. DOI: https://doi.org/10.1002/14651858.CD013251.pub2
McVary KT, Rogers T, Roehrborn CG. Rezu¯m Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study. Urology 2019; 126:171-179. DOI: https://doi.org/10.1016/j.urology.2018.12.041
Miller LE, Chughtai B, McVary K, et al. Water vapor thermal therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia: Systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21365. DOI: https://doi.org/10.1097/MD.0000000000021365
Chung ASJ, Woo HH. Update on minimally invasive surgery and benign prostatic hyperplasia. Asian J Urol 2018; 5:22-27. DOI: https://doi.org/10.1016/j.ajur.2017.06.001
Babar M, Loloi J, Tang K, et al. Emerging outcomes of water vapor thermal therapy (Rezum) in a broad range of patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia: A systematic review. LUTS Low Urin Tract Symptoms 2022; 14:140-154. DOI: https://doi.org/10.1111/luts.12435
Campobasso D, Siena G, Chiodini P, et al. Composite urinary and sexual outcomes after Rezum: an analysis of predictive factors from an Italian multi-centric study. Prostate Cancer Prostatic Dis 2023; 26:410-414. DOI: https://doi.org/10.1038/s41391-022-00587-6
Ines M, Babar M, Singh S, et al. Real-world evidence with The Rezu¯m System: A retrospective study and comparative analysis on the efficacy and safety of 12 month outcomes across a broad range of prostate volumes. The Prostate 2021; 81:956-970. DOI: https://doi.org/10.1002/pros.24191
McVary KT, Gange SN, Gittelman MC, et al. Minimally Invasive Prostate Convective Water Vapor Energy Ablation: A Multicenter, Randomized, Controlled Study for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. J Urol 2016; 195:1529-1538. DOI: https://doi.org/10.1016/j.juro.2015.10.181
Bassily D, Wong V, Phillips JL, et al. Rezu¯m for retention—retrospective review of water vaporization therapy in the management of urinary retention in men with benign prostatic hyperplasia. The Prostate 2021; 81:1049-1054. DOI: https://doi.org/10.1002/pros.24201
Johnston MJ, Noureldin M, Abdelmotagly Y, et al. Rezum water vapour therapy: promising early outcomes from the first UK series. BJU Int 2020; 126:557-558. DOI: https://doi.org/10.1111/bju.15203
Siena G, Cindolo L, Ferrari G, et al. Water vapor therapy (Rezu¯m) for lower urinary tract symptoms related to benign prostatic hyperplasia: early results from the first Italian multicentric study. World J Urol 2021; 39:3875-3880. DOI: https://doi.org/10.1007/s00345-021-03642-4
Bole R, Gopalakrishna A, Kuang R, et al. Comparative Postoperative Outcomes of Rezu¯m Prostate Ablation in Patients with Large Versus Small Glands. J Endourol 2020; 34:778-781. DOI: https://doi.org/10.1089/end.2020.0177
Garden EB, Shukla D, Ravivarapu KT, et al. Rezum therapy for patients with large prostates (≥ 80 g): initial clinical experience and postoperative outcomes. World J Urol 2021; 39:3041-3048. DOI: https://doi.org/10.1007/s00345-020-03548-7
Hoekstra RJ, Van Melick HHE, Kok ET, Ruud Bosch JLH. A 10-year follow-up after transurethral resection of the prostate, contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia; long-term results of a randomized controlled trial: 10-year follow-up after TURP, contact laser prostatectomy and electrovaporization for BPH. BJU Int. 2010; 106:822-826. DOI: https://doi.org/10.1111/j.1464-410X.2010.09229.x
Dixon C, Cedano ER, Pacik D, et al. Two-year results after convective radiofrequency water vapor thermal therapy of symptomatic benign prostatic hyperplasia. Res Rep Urol Volume 2016; 8:207-216. DOI: https://doi.org/10.2147/RRU.S119596
Tafuri A, Panunzio A, De Carlo F, et al. Transperineal Laser Ablation for Benign Prostatic Enlargement: A Systematic Review and Pooled Analysis of Pilot Studies. J Clin Med 2023; 12:1860. DOI: https://doi.org/10.3390/jcm12051860
Pacella CM, Patelli G, Iapicca G, et al. Transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: a feasibility study. Results at 6 and 12 months from a retrospective multi-centric study. Prostate Cancer Prostatic Dis 2020; 23:356-363. DOI: https://doi.org/10.1038/s41391-019-0196-4
De Rienzo G, Lorusso A, Minafra P, et al. Transperineal interstitial laser ablation of the prostate, a novel option for minimally invasive treatment of benign prostatic obstruction. Eur Urol 2021; 80:95-103. DOI: https://doi.org/10.1016/j.eururo.2020.08.018
Cai H-J, Fang J-H, Kong F-L, et al. Ultrasound-guided transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: a new minimally invasive interventional therapy. Acta Radiol 2022; 63:553-558. DOI: https://doi.org/10.1177/02841851211003289
Manenti G, Perretta T, Calcagni A, et al. 3-T MRI and clinical validation of ultrasound-guided transperineal laser ablation of benign prostatic hyperplasia. Eur Radiol Exp 2021; 5:41. DOI: https://doi.org/10.1186/s41747-021-00239-9
Patelli G, Ranieri A, Paganelli A, et al. Transperineal Laser Ablation for Percutaneous Treatment of Benign Prostatic Hyperplasia: A Feasibility Study. Cardiovasc Intervent Radiol 2017; 40:1440-1446. DOI: https://doi.org/10.1007/s00270-017-1662-9
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 2021; 39:3867-3873. DOI: https://doi.org/10.1007/s00345-021-03685-7
Minafra P, DE Rienzo G, Gerbasi S, Cindolo L, Battaglia M, Ditonno P. Three years outcomes of transperineal laser ablation of the prostate. Minerva Urol Nephrol. 2023; 75:471-478. DOI: https://doi.org/10.23736/S2724-6051.23.05270-9
Rosati D, Lombardo R, De Nunzio C, et al. Transperineal Interstitial Laser Ablation of the Prostate, A Novel Option for Minimally Invasive Treatment of Benign Prostatic Obstruction. Eur Urol 2021; 80:673-674. DOI: https://doi.org/10.1016/j.eururo.2021.08.019
Sessa F, Bisegna C, Polverino P, et al. Transperineal laser ablation of the prostate (TPLA) for selected patients with lower urinary tract symptoms due to benign prostatic obstruction: a step-by-step guide. Urol Video J 2022; 15:100167. DOI: https://doi.org/10.1016/j.urolvj.2022.100167
Bertolo R, Iacovelli V, Cipriani C, et al. Ejaculatory function following transperineal laser ablation vs TURP for benign prostatic obstruction: a randomized trial. BJU Int 2023; 132:100-108. DOI: https://doi.org/10.1111/bju.16008
Magistro G, Stief CG, Woo HH. Mini-Review: What Is New in Urolift? Eur Urol Focus 2018; 4:36-39. DOI: https://doi.org/10.1016/j.euf.2018.01.013
Roehrborn CG, Gange SN, Shore ND, et al. The Prostatic Urethral Lift for the Treatment of Lower Urinary Tract Symptoms Associated with Prostate Enlargement Due to Benign Prostatic Hyperplasia: The L.I.F.T. Study. J Urol 2013; 190:2161-2167. DOI: https://doi.org/10.1016/j.juro.2013.05.116
Jones P, Rai BP, Aboumarzouk O, Somani BK. UroLift: a new minimally-invasive treatment for benign prostatic hyperplasia. Ther Adv Urol 2016; 8:372-376. DOI: https://doi.org/10.1177/1756287216671497
Gratzke C, Barber N, Speakman MJ, et al. Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. BJU Int 2017; 119:767-775. DOI: https://doi.org/10.1111/bju.13714
Rukstalis D, Rashid P, Bogache WK, et al. 24-month durability after crossover to the prostatic urethral lift from randomised, blinded sham. BJU Int 2016; 118:14-22. DOI: https://doi.org/10.1111/bju.13666
Roehrborn CG, Barkin J, Gange SN, et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol 2017; 24:8802-8813.
Tutrone RF, Schiff W. Early patient experience following treatment with the UroLift prostatic urethral lift and Rezum steam injection. Can J Urol 2020; 27:10213-10219.
Cantwell AL, Bogache WK, Richardson SF, et al. Multicentre prospective crossover study of the ‘prostatic urethral lift’ for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: PUL for the treatment of LUTS. BJU Int 2014; 113:615-622. DOI: https://doi.org/10.1111/bju.12540
Pollock GR, Bergersen A, Chaus FM, Gretzer M. Pelvic Hematoma Following UroLift procedure for BPH. Urology 2019; 133:e3-e4. DOI: https://doi.org/10.1016/j.urology.2019.08.015
Cai PY, Gaffney C, Vanden Berg RW, et al . Pelvic Hematoma following Urolift Procedure for BPH. Urology 2020; 137:208. DOI: https://doi.org/10.1016/j.urology.2019.11.040
Ewing B, Alavi-Dunn N, Hamann H, Danforth T. Large pelvic hematoma following UroLift procedure causing renal failure requiring dialysis. Urol Case Rep 2021; 34:101514. DOI: https://doi.org/10.1016/j.eucr.2020.101514
Amparore D, De Cillis S, Volpi G, et al First- and Second-Generation Temporary Implantable Nitinol Devices As Minimally Invasive Treatments for BPH-Related LUTS: Systematic Review of the Literature. Curr Urol Rep 2019; 20:47. DOI: https://doi.org/10.1007/s11934-019-0912-6
Balakrishnan D, Jones P, Somani BK. iTIND: the second-generation temporary implantable nitinol device for minimally invasive treatment of benign prostatic hyperplasia. Ther Adv Urol 2020; 12:1756287220934355. DOI: https://doi.org/10.1177/1756287220934355
Porpiglia F, Fiori C, Bertolo R, et al. Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow-up. BJU Int 2015; 116:278-287. DOI: https://doi.org/10.1111/bju.12982
Porpiglia F, Fiori C, Amparore D, et al. Second-generation of temporary implantable nitinol device for the relief of lower urinary tract symptoms due to benign prostatic hyperplasia: results of a prospective, multicentre study at 1 year of follow-up. BJU Int 2019; 123:1061-1069. DOI: https://doi.org/10.1111/bju.14608
De Nunzio C, Cantiello F, Fiori C, et al. Urinary and sexual function after treatment with temporary implantable nitinol device (iTind) in men with LUTS: 6-month interim results of the MT-06-study. World J Urol 2021; 39:2037-2042. DOI: https://doi.org/10.1007/s00345-020-03418-2
Chughtai B, Elterman D, Shore N, et al. The iTind Temporarily Implanted Nitinol Device for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Multicenter, Randomized, Controlled Trial. Urology 2021; 153:270-276. DOI: https://doi.org/10.1016/j.urology.2020.12.022
Kadner G, Valerio M, Giannakis I, et al. Second generation of temporary implantable nitinol device (iTind) in men with LUTS: 2 year results of the MT-02-study. World J Urol 2020; 38:3235-3244. DOI: https://doi.org/10.1007/s00345-020-03140-z
Porpiglia F, Fiori C, Bertolo R, et al. 3-Year follow-up of temporary implantable nitinol device implantation for the treatment of benign prostatic obstruction. BJU Int 2018; 122:106-112. DOI: https://doi.org/10.1111/bju.14141
Lower urinary tract symptoms in men: management | Guidance | NICE. Accessed November 29, 2021.
Lerner LB, McVary KT, Barry MJ, et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA guideline Part I - Initial Work-up and Medical Management. J Urol 2021; 206:806-817. DOI: https://doi.org/10.1097/JU.0000000000002183
Leonardi R, Bellinzoni P, Broglia L, Colombo R, De Marchi D, Falcone L, Giusti G, Grasso V, Mantica G, Passaretti G, Proietti S, Russo A, Saitta G, Smelzo S, Suardi N, Gaboardi F. Hospital care in Departments defined as COVID-free: A proposal for a safe hospitalization protecting healthcare professionals and patients not affected by COVID-19. Arch Ital Urol Androl. 2020; 92:67 DOI: https://doi.org/10.4081/aiua.2020.2.67
Ambrosini F, Di Stasio A, Mantica G, et al COVID-19 pandemic and uro-oncology follow-up: A “virtual” multidisciplinary team strategy and patients’ satisfaction assessment. Arch Ital Urol Androl 2020; 92:78. DOI: https://doi.org/10.4081/aiua.2020.2.78
Dalimov Z, Hamann H, Alavi-Dunn N, et al. Trends in minimally invasive surgical therapies for benign prostatic hyperplasia: treatment substitution or treatment expansion effect by prostatic urethral lift? J Urol 2020; 203(Suppl 4S):e621. DOI: https://doi.org/10.1097/JU.0000000000000893.09

How to Cite

Leonardi, R., Ambrosini, F., Malinaric, R., Cafarelli, A., Calarco, A., Colombo, R., de Cobelli, O., De Marco, F., Ferrari, G., Ludovico, G., Pecoraro, S., Tuzzolo, D., Terrone, C., & Mantica, G. (2023). New minimally invasive solutions for Benign Prostatic Obstruction (BPO) management: A position paper from the UrOP (Urologi Ospedalità Gestione Privata). Archivio Italiano Di Urologia E Andrologia, 95(4). https://doi.org/10.4081/aiua.2023.12003