Minimally invasive surgical treatments (MISTs) are many promising approaches for the management of benign prostate hyperplasia (BPH) that might be performed under local anesthesia (LA) and have same-day discharge. To address the feasibility and efficacy of LA for BPH-MIST, a specific trifecta was conceptualized and tested: (1) no intraoperative complications, (2) reduced intraoperative pain, and (3) same-day discharge.
We prospectively collected data from patients who underwent Rezum, Urolift, and iTIND treatments from January 01, 2023, to February 28, 2024, on an international database. All the patients received a local administration of two anesthetic gels in the urethra before the procedure; selected patients, in addition, received a transperineal anesthetic injection in the periprostatic space or transurethrally with a Schelin Catheter (SC) injection directly in the prostatic lobes. Reduced intraoperative pain was defined as <5 on the visual analogue scale (VAS range: 0-10).
Overall, 156 patients were included in the study. Median age was 63.5 (interquartile range [IQR]: 56-70) years. Eleven patients (7.0%) had diabetes, and 29 (18.6%) received anticoagulant medication. Ten patients (6.4%) had indwelling catheters. The median prostate size was 45 ml (IQR: 34-60). Forty-eight patients underwent Urolift (30.8%), 70 (44.8%) Rezum, and 38 (24.4%) iTIND. The transperineal block and the SC were used in 21 patients (13.5%) and 32 (20.5%) patients, respectively, with 103 (66%) patients receiving only the anesthetic gels in the urethra. Performing MIST in pure LA achieved the trifecta outcome in 122 patients (78.2%). Six patients (3.8%) had intraoperative complications. One hundred and thirty patients (83.3%) experienced reduced intraoperative pain (<5 on VAS). One hundred and 47 (94.2%) patients were discharged on the same day of the procedure.
LA for MIST in BPH is feasible, with excellent success rates and reduced pain, as trifecta outcomes were achieved.
Urology annals. 2025 Oct 17 [Epub]
Alberto Olivero, Sinan Khadhouri, Erika Palagonia, Paolo Dell'Oglio, Stefano Tappero, Barend Dreyer, Aldo Massimo Bocciardi, Alberto Caviglia, Antonio Galfano, Feras Al Jaafari, Bhaskar K Somani, Amelia Pietropaolo, Silvia Secco
Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Department of Urology, School of Medicine, University of St. Andrews, St Andrews, UK., Department of Urology, NHS Fife, Victoria Hospital, Kirkcaldy, UK., Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK., European Association of Urology-Young Academic Urologists Urolithiasis and Endourology Working Group, Arnhem, Netherlands.