Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy.
Urology Unit, Ospedale Sant'Andrea, La Sapienza University of Rome, Rome, Italy.
Prostate Cancer Prostatic Dis. 2024 Dec;27(4):693-699. doi: 10.1038/s41391-023-00736-5. Epub 2023 Oct 18.
In our study, we aimed to test the efficacy and safety of Trans-Perineal Laser Ablation of the prostate (TPLA®) in the surgical treatment of high-risk Benign Prostatic Obstruction (BPO) patients.
We defined a high-risk BPO patient as an elderly man affected by severe comorbidities, among which coagulation issues due to pre-existent medications or diseases. From October 2020 to June 2022, we prospectively enrolled high-risk patients affected by a moderate to severe and/or complicated BPO condition. The analysis of the efficacy of the Trans-Perineal Laser Ablation was defined as the primary endpoint of the study. Secondary endpoints were post-operative surgical complications and patient-reported quality of life.
Globally, 40 consecutive patients were enrolled. Median (IQR) age was 80 (72.5-84) years. Median Charlson Comorbidity Index was 6 (5-7). Median prostate volume was 38 (30.5-73) cc. In all cases, a TPLA® procedure was performed under local anesthesia, and patients being discharged within the same day of the procedure. A progressive reduction of median prostate volumes was reported at 3 and 6 months post-operatively, compared to baseline [38 (30.5-73) vs 35 (26-49) vs 34 (28-49) cc, p < 0.001]. Median International Prostate Symptom Score (IPSS) improved accordingly [25 (19-30) vs 10.5 (7.5-13) vs 8 (6-11.5), p < 0.001]. A permanent bladder catheter was successfully removed in 13 out of 23 (56.5%) cases. Within 90 days from surgery, 19 (47.5%) patients experienced at least one surgical complication. According to the Clavien-Dindo classification, complications were classified as grade I in 16 (40%) cases, grade II in 9 (22.5%), and grade III in 1 (2.5%). We did not observe any grade IV or V complications.
The Trans-Perineal Laser Ablation of the Prostate is a feasible, safe, and effective Minimally Invasive Surgical Technique, when offered to elderly, high-risk patients affected by severe Benign Prostatic Obstruction.
在我们的研究中，我们旨在测试经会阴激光前列腺消融术（TPLA®）在治疗高危良性前列腺增生（BPO）患者中的疗效和安全性。
我们将高危 BPO 患者定义为患有严重合并症的老年男性，其中包括由于先前的药物或疾病引起的凝血问题。从 2020 年 10 月至 2022 年 6 月，我们前瞻性地招募了患有中重度和/或复杂 BPO 疾病的高危患者。经会阴激光前列腺消融术的疗效分析被定义为研究的主要终点。次要终点是术后手术并发症和患者报告的生活质量。
总共纳入了 40 名连续患者。中位（IQR）年龄为 80（72.5-84）岁。中位 Charlson 合并症指数为 6（5-7）。中位前列腺体积为 38（30.5-73）cc。在所有情况下，均在局部麻醉下进行 TPLA®手术，患者在手术当天出院。与基线相比，术后 3 个月和 6 个月时报告的中位前列腺体积逐渐减少[38（30.5-73）vs 35（26-49）vs 34（28-49）cc，p<0.001]。国际前列腺症状评分（IPSS）相应改善[25（19-30）vs 10.5（7.5-13）vs 8（6-11.5），p<0.001]。23 例（56.5%）患者中成功去除永久性膀胱导管。术后 90 天内，19 例（47.5%）患者至少发生 1 例手术并发症。根据 Clavien-Dindo 分类，并发症在 16 例（40%）患者中为 I 级，在 9 例（22.5%）患者中为 II 级，在 1 例（2.5%）患者中为 III 级。我们未观察到任何 IV 级或 V 级并发症。
经会阴激光前列腺消融术是一种可行、安全且有效的微创外科技术，适用于患有严重良性前列腺增生的高危老年患者。
