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| 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 Wroclawskid,e,f,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
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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 |
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Abstract 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.
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Received: 09 August 2021
Available online: 20 January 2024
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Corresponding Authors:
*E-mail address: bryan.ckc@gmail.com (B. Kwun-Chung Cheng).
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| Characteristic | Value, n (%) | | Demographics of respondents (n=755) | | Age, year | | <30 | 94 (12.5) | | 30-39 | 258 (34.2) | | 40-49 | 207 (27.4) | | 50-59 | 120 (15.9) | | ≥60 | 76 (10.1) | | Gender | | Male | 711 (94.2) | | Female | 44 (5.8) | | Location of practice | | North America | 48 (6.4) | | Europe | 329 (43.6) | | Asia | 269 (35.6) | | South America | 82 (10.9) | | Africa | 21 (2.8) | | Australia and New Zealand | 6 (0.8) | | Type of practice | | Teaching hospital or academic institution | 413 (54.7) | | Non-academic public hospital | 142 (18.8) | | Private practice | 200 (26.5) | | Level of experience | | Urology resident in training or registrar | 124 (16.4) | | Urology fellow/specialist | 239 (31.7) | | Urology consultant | 392 (51.9) | | Experience of BPO surgery (n=225) | | Number of BPO surgeries performed annually | | <20 | 26 (11.6) | | 20-50 | 86 (38.2) | | 50-100 | 75 (33.3) | | 100-200 | 26 (11.6) | | >200 | 12 (5.3) | | Type of BPO surgeries performeda | | Convective water vapor energy ablation (Rezum®) | 30 (13.3) | | Endoscopic enucleation of the prostate | 125 (55.6) | | Image-guided robotic waterjet ablation (Aquablation®) | 13 (5.8) | | Prostatic arterial embolization | 1 (0.4) | | Prostatic urethral lift (Urolift®) | 32 (14.2) | | Robotic or laparoscopic simple prostatectomy | 0 (0) | | Temporary implantable nitinol device (iTIND®) | 18 (8.0) | | Vaporization | 91 (40.4) | | None of the above | 63 (28.0) |
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Demographics of respondents and experiences of BPO surgeries.
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| Outcomea | Convectivewatervaporenergyablation(Rezum®) | Endoscopicenucleation of the prostate | Image-guidedroboticwaterjetablation (Aquablation®) | Prostaticarterialembolization | Prostaticurethrallift(Urolift®) | Temporaryimplantablenitinoldevice (iTIND®) | Robotic or laparoscopic simple prostatectomy | Vaporization | | Lower transfusion rate | ✓ | ✓ | | | ✓ | ✓ | | ✓ | | Shorter LOS | ✓ | | | | ✓ | ✓ | | ✓ | | Shorter duration of catheterization | | | | | ✓ | ✓ | | | | Feasibility of day surgery | ✓ | | | | ✓ | ✓ | | | | Lower Post-op ejaculatory dysfunction | | | | | ✓ | ✓ | | | | Lower Post-op urinary incontinence | ✓ | | | | ✓ | ✓ | | | | Better for prostate >80 mL | | ✓ | | ✓ | | | ✓ | | | Higher Qmax at Post-op 12 mos | | ✓ | | | | | | | | Lower IPSS at Post-op 12 mos | | ✓ | | | | | | | | Lower retreatment rate at Post-op 3 years | | ✓ | | | | | | | | Steeper learning curve | | ✓ | | | | | ✓ | |
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Consensus on knowledge of new surgical options compared with TURP.
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| Outcomea | Convectivewatervaporenergyablation(Rezum®) | Endoscopicenucleationof the prostate | Image-guidedroboticwaterjetablation(Aquablation®) | Prostaticarterialembolization | Prostaticurethrallift(Urolift®) | Robotic or laparoscopic simpleprostatectomy | Temporaryimplantablenitinoldevice (iTIND®) | Vaporization | | Lower transfusion rate | ✓ | ✓ | | ✓ | ✓ | | ✓ | ✓ | | Shorter LOS | ✓ | | | | ✓ | | ✓ | | | Shorter duration of catheterization | | | | | ✓ | | ✓ | | | Feasibility of day surgery | ✓ | | | | ✓ | | ✓ | | Lower Post-op ejaculatory dysfunction | | | | | ✓ | | ✓ | | Lower Post-op urinary incontinence | | | | | ✓ | | ✓ | | Better for prostate >80 mL | | ✓ | | | | | | | Higher Qmax at Post-op 12 mos | | ✓ | | | | | | | Lower IPSS at Post-op 12 mos | | ✓ | | | | | | | Lower retreatment rate at Post-op 3 years | | ✓ | | | | | | | Steeper learning curve | | ✓ | | | | ✓ | |
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Consensus on attitudes of new surgical options compared with TURP.
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| Outcome | Convectivewatervaporenergyablation(Rezum®) | Endoscopicenucleationof the prostate | Image-guidedroboticwaterjetablation(Aquablation®) | Prostaticarterialembolization | Prostaticurethrallift(Urolift®) | Robotic of laparoscopic simpleprostatectomy | Temporaryimplantablenitinoldevice (iTIND®) | Vaporization | | 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) |
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Consensus on practices of benign prostatic obstruction surgeries compared with transurethral resection of the prostate.
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| 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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Summary of responses on MIST definitions.
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| [1] |
Martin SA, Haren MT, Marshall VR, Lange K, Wittert GA; Members of the Florey Adelaide Male Ageing Study. Prevalence and factors associated with uncomplicated storage and voiding lower urinary tract symptoms in community-dwelling Australian men. World J Urol 2011; 29:179-84.
doi: 10.1007/s00345-010-0605-8
pmid: 20963421
|
| [2] |
Yee CH, Chan CK, Teoh JYC, Chiu PKF, Wong JHM, Chan ESY, et al. Survey on prevalence of lower urinary tract symptoms in an Asian population. Hong Kong Med J 2019; 25:13-20.
doi: 10.12809/hkmj187502
pmid: 30655460
|
| [3] |
Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, et al. EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2015; 67:1099-109.
doi: S0302-2838(14)01394-3
pmid: 25613154
|
| [4] |
McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 2011; 185:1793-803.
doi: 10.1016/j.juro.2011.01.074
pmid: 21420124
|
| [5] |
Christidis D, McGrath S, Perera M, Manning T, Bolton D, Lawrentschuk N. Minimally invasive surgical therapies for benign prostatic hypertrophy: the rise in minimally invasive surgical therapies. Prostate Int 2017; 5:41-6.
doi: 10.1016/j.prnil.2017.01.007
pmid: 28593165
|
| [6] |
Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 2015; 67:1066-96.
doi: 10.1016/j.eururo.2014.06.017
|
| [7] |
Bhojani N, Yafi FA, Misrai V, Rijo E, Chughtai B, Zorn KC, et al. Review of sexual preservation after novel benign prostatic hyperplasia surgical treatment modalities from food and drug administration clinical trials. Sex Med Rev 2021; 9:169-73.
doi: 10.1016/j.sxmr.2020.09.003
pmid: 33309271
|
| [8] |
Teoh JY, MacLennan S, Chan VW, Miki J, Lee HY, Chiong E, et al. An international collaborative consensus statement on en bloc resection of bladder tumour incorporating two systematic reviews, a two-round Delphi survey, and a consensus meeting. Eur Urol 2020; 78:546-69.
doi: 10.1016/j.eururo.2020.04.059
|
| [9] |
Yu X, Elliott SP, Wilt TJ, McBean AM. Practice patterns in benign prostatic hyperplasia surgical therapy: the dramatic increase in minimally invasive technologies. J Urol 2008; 180:241-5.
doi: 10.1016/j.juro.2008.03.039
pmid: 18499180
|
| [10] |
Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol 2005; 173:1256-61.
doi: 10.1097/01.ju.0000155709.37840.fe
pmid: 15758764
|
| [11] |
Parsons JK, Dahm P, Kohler TS, Lerner LB, Wilt TJ. Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline amendment 2020. J Urol 2020; 204:799-804.
doi: 10.1097/JU.0000000000001298
pmid: 32698710
|
| [12] |
Tzeng M, Basourakos SP, Lewicki PJ, Hu JC, Lee RK. New endoscopic in-office surgical therapies for benign prostatic hyperplasia: a systematic review. Eur Urol Focus 2021; 8: 522-31.
doi: 10.1016/j.euf.2021.02.013
pmid: 33663982
|
| [13] |
Agarwal DK, Large T, Tong Y, Stoughton CL, Damler EM, Nottingham CU, et al. Same day discharge is a successful approach for the majority of patients undergoing holmium laser enucleation of the prostate. Eur Urol Focus 2022; 8: 228-34.
|
| [14] |
Elterman DS, Zorn KC, Chughtai B, Bhojani N. Is it time to offer True Minimally Invasive Treatments (TMIST) for BPH? A review of office-based therapies and introduction of a new technology category. Can J Urol 2021; 28:10580-3.
pmid: 33872553
|
| [15] |
Porpiglia F, Fiori C, Bertolo R, Giordano A, Checcucci E, Garrou D, et al. 3-Year follow-up of temporary implantable nitinol device implantation for the treatment of benign prostatic obstruction. BJU Int 2018; 122:106-12.
doi: 10.1111/bju.14141
pmid: 29359881
|
| [16] |
Gratzke C, Barber N, Speakman MJ, Berges R, Wetterauer U, Greene D, et al. Prostatic urethral lift vs. transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. BJU Int 2017; 119: 767-75.
doi: 10.1111/bju.13714
pmid: 27862831
|
| [17] |
Gudaru K, Gonzalez Padilla DA, Castellani D, Tortolero Blanco L, Tanidir Y, Ka Lun L, et al. A global knowledge, attitudes and practices survey on anatomical endoscopic enucleation of prostate for benign prostatic hyperplasia among urologists. Andrologia 2020; 52:e13717. https://doi.org/10.1111/and.13717.
|
| [18] |
Enikeev D, Morozov A, Taratkin M, Misrai V, Rijo E, Podoinitsin A, et al. Systematic review of the endoscopic enucleation of the prostate learning curve. World J Urol 2021; 39:2427-38.
doi: 10.1007/s00345-020-03451-1
|
| [19] |
Teoh JY, Cho CL, Wei Y, Isotani S, Tiong HY, Ong TA, et al. Surgical training for anatomical endoscopic enucleation of the prostate. Andrologia 2020; 52:e13708. https://doi.org/10.1111/and.13708.
|
| [20] |
Wettstein MS, Pazhepurackel C, Neumann AS, Woon DTS, Herrera-Caceres JO, Kozomara M, et al. Photoselective vaporization of the prostate: study outcomes as a function of risk of bias, conflicts of interest, and industrial sponsorship. World J Urol 2020; 38:741-6.
doi: 10.1007/s00345-019-02799-3
pmid: 31087122
|
| [21] |
Wilson CB. Adoption of new surgical technology. BMJ 2006; 332:112-4.
doi: 10.1136/bmj.332.7533.112
|
| [22] |
Castellani D, Wroclawski ML, Pirola GM, Gauhar V, Rubilotta E, Chan VW, et al. Bladder neck stenosis after transurethral prostate surgery: a systematic review and meta-analysis. World J Urol 2021; 39:4073-83.
doi: 10.1007/s00345-021-03718-1
pmid: 33974100
|
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