3-T MRI and Clinical Validation of Ultrasound-Guided Transperineal Laser Ablation of Benign Prostatic Hyperplasia - Beyond the Abstract

Despite the fact that in recent years urology is facing an increasing availability of different technologies for the treatment of BPO (Benign Prostatic Obstruction), TURP still represents the “gold standard” therapeutic approach for the treatment of such pathology. However, TURP approach bears with it its own limitations: these include high complications rate such as retrograde ejaculation, erectile dysfunction, urethral stricture, urinary tract infection (UTI), bleeding requiring transfusions, and urinary incontinence.

Laser enucleation (HoLEP or ThuLEP) and photoselective vaporisation of the prostate (Green Laser) have improved the outcome versus TURP, especially with regards to bleeding, but anesthesia-related risks and side effects like incontinence or sexual dysfunctions still remain. More recently water vapour thermal therapy (Rezum), hydrodissection (Aquablation), and prostatic urethral lift (Urolift) are gaining traction. However, each of these emerging techniques are performed transurethrally and do not overcome problems related to laser surgery (also, risk of Urolift migration has been reported in the literature).

In this scenario, EchoLaser SoracteLiteTM transperineal laser ablation (TPLA) offers some advantages over other techniques. In fact, TPLA is performed with a transperineal approach, already widely performed for other procedures like prostate biopsies, allowing to avoid any damage to the urethral channel, thus reducing post-treatment irritative symptoms associated with the urothelial damage and the risk of post-procedural UTIs. Moreover, the precision of the laser source in the energy depletion within the organ, together with the availability of a dedicated treatment planning and guiding system, allows the clinician to perform a controlled and predictable ablation area, which can be monitored in real-time throughout the procedure, thus minimizing the risk of damage on surrounding structures (i.e. bladder neck) associated with possibly related side effects like retrograde ejaculation, urinary incontinence or sexual dysfunctions.

Finally, due to the micro-invasiveness of the procedure related to the transperineal route approach and the use of the smallest available applicators on the market, the treatment can be easily performed under conscious sedation and with only local anesthesia, differently from other techniques which often require general and spinal anesthesia. Reduced operation time and absence of hospitalization allowing a fast patient management are additional fundamental features, especially in the current times characterized by a worldwide critical situation for health care systems due to the Covid-19 pandemic. The above-reported concepts were confirmed by our publication outcomes, the first-ever reported clinical evaluation of TPLA supported by 3-T MRI follow-up exams, allowing a reliable monitoring of the necrotic area volume and the assessment of the prostatic volume decrease and the ablated cavum size.

Written by: Guglielmo Manenti, Tommaso Perretta, Antonello Calcagni, Donatella Ferrari, Colleen P Ryan, Federico Fraioli, Rosaria Meucci, Andrea Malizia, Valerio Iacovelli, Enrico Finazzi Agrò, Roberto Floris

Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy., Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy., Department of Neuromotor Physiology, Fondazione Santa Lucia IRCCS, Rome, Italy., Department of Urology, University of Rome "Tor Vergata", Rome, Italy.

A visual overview of the procedure is available in the below reported video:

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