(233) Treatment of Benign Prostatic Hyperplasia. How to Preseve the Ejaculatory Function with the Transperineal Laser Ablation of the Prostate
Authors: Ruffo A , Esposito F , Scarpato A , Trama F , Riccardo F , Stanojevic N 
Published: May 2023

Abstract

Introduction
Benign prostatic hyperplasia (BPH) can be the cause of Lower urinary tract symptomps (LUTS). Endoscopic treatments like the trans-urethral resection of the prostate (TURP) is still the gold standard technique to treat this condition. This technique often leads to sexual dysfunction as retrograde ejaculation.

Objective
The objective of the study was to evaluate the safety and the efficacy of this new technique. The transperineal laser ablation of the prostate (TPLA) is a new minimal invasive technique used to treat BPH that reduces the prostate volume preserving the ejaculatory function.

Methods
This is a prospective study done in accordance with the Declaration of Helsinki. 168 patients (pts) (age 60.5 ± 10.5 years) with LUTS and BPH were enrolled. Mean prostate volume was 71.5 ± 25.5 m (from 30 to 100 grams). Inclusions criteria were: Peak urinary flow (Q max): ≤15 mL/sec, International Prostatic Symptoms Score (IPSS) &gt;19, Postvoid residual (PVR): &gt; 100 mL. Exclusion criteria were: catheterized pts, history of neurodegenerative disease, positive urinary culture, prostate volume &gt; 100 grams, Clinical suspicion of prostate cancer (Abnormal digital rectal examination, PSA levels). The procedure was performed under local anaesthesia (Periprostatic nerve block) plus sedation. Under US guidance, up to four 21G applicators with a length of 15 cm were inserted into the prostate tissue. Each treatment was performed with diode lasers operating at 980 nm with 1800 joules per lobe at a power of 5 watts. The primary endpoint was the reduction of prostate volume (misured at 6 months follow-up) and preservation of the ejaculation in the treated pts. Secondary endpoints included operating time, ablation time, energy used, hospitalization time, catheterization time and International Prostate Symptom Score (IPSS) variation, quality of life (QoL), Q max and PVR.

Results
All procedures have been successful from a technical point of view. The average operating time was (38 ± 6.5 min) and the average ablation time was (12.4 ± 2.8 min). The average energy used was (11.622 ± 4350.5 J), the average hospital stay was (1.7 ± 0.2 days) and the average catheterization time was (6.1 ± 4.0 days.) At 6 months, IPSS improved from (22.5±2.1 points) to (12.3±1.8 points) (P &lt; 0.001). QoL was improved from (4.8±0.2) to (1.8. ± 0.3) (P &lt; 0.05) and Q max was improved from (4.6 ± 3.1 mL/s) to (12.8 ±2.6 mL/s) (P &lt; 0.001). Moreover, PVR was improved from (120±59.3 ml) to (46.7±27.9ml) (P&lt;0.001); the average prostate volume at 6 months improved from (71.5 ± 25.5 grams) to (48.8 ± 21.8 grams) (P &lt; 0.05). 130 out of 150 sexually active subjects (86.6%) maintained ejaculation following treatment at 6 months. 44 subjects (26,5%) needed recatheterization for acute urinary retention. Perineal pain was reported in 5 subjects, urethrorrhagia in 8 subjects.

Conclusions
TPLA is a safe, feasible and promising procedure for the treatment of LUTS in BPH. This procedure induces coagulative necrosis in the treated tissue, reducing the prostate volume while preserving the ejaculatory function

Disclosure
No