Transperineal Laser Ablation vs Transurethral Resection for Benign Prostatic Obstruction: A Randomized Clinical Trial
Condition: Prostate Hyperplasia; Benign Prostatic Hyperplasia; Benign Prostatic Hypertrophy; Benign Prostatic Hypertrophy With Outflow Obstruction
MeSH terms: Prostatic Hyperplasia; Hyperplasia; Hypertrophy
Study type: Interventional

Summary: 
      The primary objective of the study is to compare Trans-Perineal Laser Ablation of Prostate
      versus Trans-Urethral Resection of Prostate in the immediate impact on post-operative pain;
      in terms of relief in benign prostatic obstruction and preservation of the ejaculatory
      function in the short term (at 1, 3 and 6 months).

      The secondary objective of the study is the evaluation of the long-term deobstructive
      effectiveness (12 months).
    

Detailed description: 
      Consecutive patients coming to our institution affected by benign prostatic obstruction (BPO)
      with indication to surgery and strong need of ejaculatory preservation will be enrolled in
      the present randomised controlled trial study after counseling. After an informed consent is
      obtained, uroflowmetry with calculation of the post-voiding residual volume (PVR), a
      transrectal ultrasonography to estimate prostate volume (PVol), the international prostate
      symptoms score (IPSS) questionnaire with quality of life (QoL) assessment, and the evaluation
      of the ejaculatory sexual function will be performed in all patients.

      Trans-Perineal Laser Ablation of Prostate (TPLA) will be performed using the EchoLaser
      combined system (Elesta, Italy).

      During the procedure, two 21G spinal needles are inserted transperineally in the
      peri-urethral area under ultrasound-guidance. By optical fibers, a maximum energy of 1800 J
      at a power of 3 Watts is delivered. If necessary, the fibers are eventually pulled-back.
      Immediately after the procedure, the patients will be asked to fill in the Visual Analogue
      Scale (VAS) for the assessment of the pain perceived. Perioperative data and postoperative
      data including assessment of ejaculatory function will be analyzed at different time points.
    

Intervention name(s): Trans-Perineal Laser Ablation of Prostate; Trans-Urethral Resection of Prostate
Intervention type(s): Procedure; Procedure
Intervention description(s): TPLA treatment will be performed using the EchoLaser EVO system (Elesta SpA - Calenzano, FI, Italy). EchoLaser EVO consists of four echolasers, a multi-source laser system with a wavelength of 1064nm and Echolaser Smart Interface (ESI), a treatment planning device for safely inserting introductor needles and optical fibers into prostate tissue. EchoLaser therapy is a micro-invasive percutaneous procedure that uses laser light transmitted through applicators (optical fibers) for a few minutes, causing a heating of the affected tissue to its irreversible damage in "situ", without the need to remove it. EchoLaser therapy, through flat-tip fibers, produces an ellipsoidal clotting area (area where the tissue has irreversible damage). EchoLaser therapy will be performed under ultrasound guidance.; TURP is the gold standard for the treatment of benign prostatic obstruction. It will be performed by using a bipolar energy resectoscope. The procedure will be carried out with patient in a lithotomic position.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: TPLA; TURP; BPH; BPO; LUTS