Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey
Bryan Kwun-Chung Chenga*(),Steffi Kar-Kei Yuenb,Daniele Castellanic,Marcelo Langer Wroclawskidef,Hongda Zhaob,Mallikarjuna Chiruvellag,Wei-Jin Chuah,Ho-Yee Tiongh,Yiloren Tanidiri,Jean de la Rosettej,Enrique Rijok,Vincent Misrail,Amy Krambeckm,Dean S. Eltermann,Bhaskar K. Somanio,Jeremy Yuen-Chun Teohb,Vineet Gauharp
aDepartment of Surgery, United Christian Hospital, Hong Kong, China bS. H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China cDepartment of Urology, University Hospital “Ospedali Riuniti” and Polytechnic University of Marche Region, Ancona, Italy dHospital Israelita Albert Einstein, Sao Paulo, SP, Brazil eBP—A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, Brazil fFaculdade de Medicina do ABC, Santo Andre, SP, Brazil gDepartment of Urology, Asian Institute of Nephrology and Urology, Hyderabad, TG, India hDepartment of Urology, National University Hospital, Singapore iDepartment of Urology, Marmara University School of Medicine, Istanbul, Turkey jDepartment of Urology, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey kDepartment of Urology, Hospital Quiron Barcelona, Barcelona, Spain lDepartment of Urology, Clinique Pasteur, Toulouse, France mDepartment of Urology, Indiana University School of Medicine, Indianapolis, IN, USA nDivision of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada oDepartment of Urology, University Hospital Southampton NHS Trust, Southampton, UK pDepartment of Urology, Ng Teng Fong General Hospital, NUHS, Singapore
Objective: To scrutinize the definitions of minimal invasive surgical therapy (MIST) and to investigate urologists’ knowledge, attitudes, and practices for benign prostatic obstruction surgeries.
Methods: A 36-item survey was developed with a Delphi method. Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included. Urologists were invited globally to complete the online survey. Consensus was achieved when more than or equal to 70% responses were “agree or strongly agree” and less than or equal to 15% responses were “disagree or strongly disagree” (consensus agree), or when more than or equal to 70% responses were “disagree or strongly disagree” and less than or equal to 15% responses were “agree or strongly agree” (consensus disagree).
Results: The top three qualities for defining MIST were minimal blood loss (n=466, 80.3%), fast post-operative recovery (n=431, 74.3%), and short hospital stay (n=425, 73.3%). The top three surgeries that were regarded as MIST were Urolift® (n=361, 62.2%), Rezum® (n=351, 60.5%), and endoscopic enucleation of the prostate (EEP) (n=332, 57.2%). Consensus in the knowledge section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regard to blood loss, recovery, day surgery feasibility, and post-operative continence. Consensus in the attitudes section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regard to blood loss, recovery, and day surgery feasibility. Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement, lower retreatment rate, and better suitable for prostate more than 80 mL.
Conclusion: Minimal blood loss, fast post-operative recovery, and short hospital stay were the most important qualities for defining MIST. Urolift®, Rezum®, and EEP were regarded as MIST by most urologists.
. [J]. Asian Journal of Urology, 2024, 11(1): 55-64.
Bryan Kwun-Chung Cheng, Steffi Kar-Kei Yuen, Daniele Castellani, Marcelo Langer Wroclawski, Hongda Zhao, Mallikarjuna Chiruvella, Wei-Jin Chua, Ho-Yee Tiong, Yiloren Tanidir, Jean de la Rosette, Enrique Rijo, Vincent Misrai, Amy Krambeck, Dean S. Elterman, Bhaskar K. Somani, Jeremy Yuen-Chun Teoh, Vineet Gauhar. Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey. Asian Journal of Urology, 2024, 11(1): 55-64.
Question: which of the following is a major issue in adopting the surgical technique?
Cost
✓
✓
Equipment availability
✓
✓
✓
✓
✓
Learning curve
✓
✓
✓
Question: what is the mode of anesthesia you would choose for each option? n (%)
LA with sedation
31 (13.8)
2 (0.9)
13 (5.8)
0
58 (25.8)
0
48 (21.3)
2 (0.9)
LA without sedation
5 (2.2)
0
0
1 (20.0)
11 (4.9)
0
12 (5.3)
0
SA
51 (22.7)
123 (54.7)
52 (23.1)
0
28 (12.4)
0
20 (8.9)
117 (52.0)
GA
14 (6.2)
54 (24.0)
16 (7.1)
0
7 (3.1)
2 (40.0)
4 (1.8)
32 (14.2)
Not practicing
124 (55.1)
46 (20.4)
144 (64.0)
4 (80.0)
121 (53.8)
3 (60.0)
141 (62.7)
74 (32.9)
Question: what is the mode of hospitalization you would arrange for each option? n (%)
Ambulatory surgery
39 (17.3)
2 (0.9)
6 (2.7)
1 (20.0)
57 (25.3)
0
44 (19.6)
17 (7.6)
Same day admission
18 (8.0)
83 (36.9)
28 (12.4)
0
17 (7.6)
1 (20.0)
15 (6.7)
72 (32.0)
In-patient
11 (4.9)
80 (35.6)
18 (8.0)
1 (20.0)
4 (1.8)
0
3 (1.3)
51 (22.7)
Not practicing
157 (69.8)
60 (26.7)
173 (76.9)
3 (60.0)
147 (65.3)
4 (80.0)
163 (72.4)
85 (37.8)
Survey response
Respondent, n (%)
Total respondent
580 (76.8)
Top three qualities in defining MIST
Minimal blood loss
466 (80.3)
Fast Post-op recovery
431 (74.3)
Short hospital stay
425 (73.3)
Top three options regarded as MIST
Urolift®
361 (62.2)
Rezum®
351 (60.5)
EEP
332 (57.2)
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