经会阴激光消融术治疗良性前列腺增生和前列腺癌：德尔菲共识项目的结果
Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project.
作者信息
Cocci Andrea, Pezzoli Marta, Bianco Fernando, Blefari Franco, Bove Pierluigi, Cornud Francois, De Rienzo Gaetano, Destefanis Paolo, Di Trapani Danilo, Giacobbe Alessandro, Giovanessi Luca, Laganà Antonino, Lughezzani Giovanni, Manenti Guglielmo, Muto Gianluca, Patelli Gianluigi, Pinzi Novello, Regusci Stefano, Russo Giorgio I, Salamanca Juan I M, Salvi Matteo, Silvestri Luigi, Verweij Fabrizio, Walser Eric, Bertolo Riccardo G, Iacovelli Valerio, Bertaccini Alessandro, Marchiori Debora, Davila Hugo, Ditonno Pasquale, Gontero Paolo, Iapicca Gennaro, M De Reijke Theo, Ricapito Vito, Pellegrini Pierluca, Minervini Andrea, Serni Sergio, Sessa Francesco
机构信息
Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
Urology Section, University of Florence, Florence, Italy.
出版信息
Asian J Urol. 2024 Apr;11(2):271-279. doi: 10.1016/j.ajur.2023.07.001. Epub 2023 Jul 11.
OBJECTIVE
To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method.
METHODS
Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized.
RESULTS
Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations.
CONCLUSION
Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.
目的
采用德尔菲共识法评估使用Echolaser®（意大利卡伦扎诺的Elesta S.p.A.公司生产的Echolaser®经会阴激光消融术，即Echolaser® TPLA）治疗良性前列腺增生（BPH）和前列腺癌（PCa）的效果。
方法
意大利及国际上的BPH和PCa专家参与了一项合作共识项目。在两轮过程中，他们就Echolaser® TPLA治疗BPH和PCa的相关问题，通过在线问卷回答了关于该技术的适应症、方法及潜在并发症等方面的意见。达成共识的同意或不同意程度设定为75%。若未达成共识，则在每轮后修改问题。在一次在线会议期间进行了最后一轮，在该轮中讨论并确定了结果。
结果
受邀的40位专家中有32位参与，所有主题均达成了共识。对于推荐Echolaser® TPLA作为治疗前列腺体积范围广泛（从<40 mL（80%）到>80 mL（80%））、合并症（100%）、抗血小板或抗凝治疗（96%）、留置导尿管（77%）以及有强烈保留射精功能意愿（100%）的BPH患者的治疗方法，达成了一致意见。大多数受访者同意Echolaser® TPLA是治疗局限性PCa的一种潜在选择（78%），并推荐用于低风险PCa（90%）。在最后一轮中，专家们得出结论，该方法可用于中风险PCa，对于有强烈避免尿失禁和性功能障碍意愿的患者，应将其作为根治性前列腺切除术的有效替代方法提出。几乎所有参与者都同意这种保留器官技术的经会阴途径比其他技术典型的经直肠和经尿道途径更安全（专家间的同意率为97%）。讨论了术前评估、技术方面、术后导尿、药物治疗及预期结果，得出了相关陈述和建议。
结论
Echolaser® TPLA是一种安全有效的治疗方法，可治疗BPH和局限性PCa，并能带来令人满意的功能和性功能结果。
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