Passarelli Federica, Castellani Daniele, Secco Silvia, Gacci Mauro, Sibona Mattia, Goumas Ioannis Kartalas, Manfredi Celeste, Ferrari Giovanni, Agrò Enrico Finazzi, Cocci Andrea, Miacola Carlos, Marenghi Carlo, D'Agostino Daniele, Arcaniolo Davide, Baldassarre Emanuele, Deho Federico, Palumbo Fabrizio, Gadda Franco, Sampogna Gianluca, Ruggera Lorenzo, Ferrando Luca, Preto Mirko, Schifano Nicolò, Capogrosso Paolo, De Lorenzis Elisa, Ismail Yasser Hussein Mohamed, Basadonna Ludovico Maria, Graps Giorgio, Longo Fabrizio, Salonia Andrea, Montanari Emanuele, Boeri Luca
Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 15, 20122, Milan, Italy.
Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy.
World J Urol. 2025 Jun 8;43(1):363. doi: 10.1007/s00345-025-05727-w.
To conduct a Delphi consensus in order to address key uncertainties and provide expert insights to bridge the gap between guidelines and real-world practice concerning minimally invasive surgical techniques (MISTs) for benign prostatic hyperplasia (BPH).
The Advisory Board developed 343 statements on 35 debated topics in the surgical management of BPH, each including multiple items rated on a 9-point Likert scale. The questionnaire was emailed to a Panel of 28 Italian urologists with 5-year experience in MISTs for the first round of voting. Statements that did not reach consensus were identified as "hot topics" and underwent a second round of voting during a Consensus conference, attended by all first-round participants, where the results were reviewed, debated, and re-voted upon anonymously.
The Panel agreed in defining TPLA, Rezum, iTIND, PAE and Urolift as MISTs, but no consensus was reached regarding Aquablation. Essential characteristics for being defined as MISTs were considered the feasibility in outpatient and one-night stay settings, minimal bleeding risk, early postoperative recovery of daily activities and a reduced impact on urinary continence and ejaculatory function. The Panel agreed that, compared to TURP, PAE, TPLA, Rezum, iTIND and Urolift were associated with lower postoperative bleeding rates, lower operative and hospitalization time, lower risk of postoperative incontinence; non consensus on these topics was achieved for Aquablation. The Panel agreed that flow rates after PAE, TPLA, iTIND and Urolift were worse than TURP, however, no consensus was achieved for Rezum and Aquablation. A high risk of retreatment was recognized for TPLA, iTIND and Urolift, but this was not the case for Rezum and Aquablation. iTIND and Urolift were deemed as the best options for prostate volume 30 ml, TPLA, Rezum and Aquablation for prostate volume 30-80 ml while no consensus was obtained for the best approach in larger volumes. No consensus was achieved for various aspects of postoperative management of MISTs.
Results from this Delphi project confirmed the lack of agreement on certain topics related to MISTs for BPH including the ideal treatment for large prostate volumes, functional outcomes and postoperative management.
进行德尔菲共识，以解决关键的不确定性问题，并提供专家见解，弥合关于良性前列腺增生（BPH）的微创手术技术（MISTs）的指南与实际临床实践之间的差距。
咨询委员会就BPH手术管理中的35个有争议的主题制定了343条陈述，每条陈述包含多个按9分李克特量表评分的项目。问卷通过电子邮件发送给28名具有5年MISTs经验的意大利泌尿科医生组成的小组，进行第一轮投票。未达成共识的陈述被确定为“热门话题”，并在共识会议期间进行第二轮投票，所有第一轮参与者均出席，会上对结果进行审查、辩论并进行匿名重新投票。
该小组一致将经尿道前列腺激光剜除术（TPLA）、Rezum热蒸汽消融术、经尿道前列腺铥激光汽化术（iTIND）、前列腺动脉栓塞术（PAE）和Urolift系统定义为MISTs，但对于水刀前列腺切除术（Aquablation）未达成共识。被定义为MISTs的基本特征被认为是在门诊和过夜住院环境中的可行性、最小的出血风险、术后日常活动的早期恢复以及对尿失禁和射精功能的影响较小。该小组一致认为，与经尿道前列腺电切术（TURP）相比，PAE、TPLA、Rezum、iTIND和Urolift术后出血率更低、手术和住院时间更短、术后尿失禁风险更低；对于Aquablation在这些方面未达成共识。该小组一致认为，PAE、TPLA、iTIND和Urolift术后的尿流率比TURP差，然而，对于Rezum和Aquablation未达成共识。TPLA、iTIND和Urolift被认为再次治疗的风险较高，但Rezum和Aquablation并非如此。iTIND和Urolift被认为是前列腺体积<30ml的最佳选择，TPLA、Rezum和Aquablation适用于前列腺体积30 - 80ml的情况，而对于更大体积前列腺的最佳治疗方法未达成共识。对于MISTs术后管理的各个方面未达成共识。
该德尔菲项目的结果证实，在与BPH的MISTs相关的某些主题上缺乏共识，包括大体积前列腺的理想治疗方法、功能结果和术后管理。
