Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project

doi:10.1016/j.ajur.2023.07.001

Asian Journal of Urology, 2024, 11 (2): 271-279 doi: 10.1016/j.ajur.2023.07.001

Regular Papers: Original Articles

Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project

Andrea Cocci^a,Marta Pezzoli^b,*(

),Fernando Bianco^c,Franco Blefari^d,Pierluigi Bove^e,f,Francois Cornud^g,Gaetano De Rienzo^h,Paolo Destefanisⁱ,Danilo Di Trapani^j,Alessandro Giacobbe^k,Luca Giovanessi^l,Antonino Laganà^m,Giovanni Lughezzani^n,o,Guglielmo Manenti^p,q,Gianluca Muto^a,Gianluigi Patelli^r,Novello Pinzi^s,Stefano Regusci^t,u,Giorgio I. Russo^v,Juan I.M. Salamanca^w,x,Matteo Salvi^a,Luigi Silvestri^y,Fabrizio Verweij^z,Eric Walser^aa,Riccardo G. Bertolo^f,ab,Valerio Iacovelli^f,Alessandro Bertaccini^ac,Debora Marchiori^ac,Hugo Davila^ad,ae,Pasquale Ditonno^h,Paolo Gontero^af,Gennaro Iapicca^ag,Theo M De Reijke^ah,Vito Ricapito^ai,Pierluca Pellegrini^y,Andrea Minervini^a,Sergio Serni^a,Francesco Sessa^a

^aDepartment of Urology, Careggi Hospital, University of Florence, Florence, Italy
^bUrology Section, University of Florence, Florence, Italy
^cUrological Research Network, Miami, FL, USA
^dUrology Section, Prato Hospital, Prato, Italy
^eTorvergata Oncoscience Research Centre of Excellence, TOR, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
^fDepartment of Urology, San Carlo di Nancy Hospital, Rome, Italy
^gDepartment of Radiology, Hôpital Cochin, Paris Descartes University, Paris, France
^hUrology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
ⁱUnit of Urology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
^jUrology Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
^kDepartment of Urology, Humanitas Gradenigo Hospital, Turin, Italy
^lUrology Unit, Surgical Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
^mDepartement of Urology, “S.Giovanni Evangelista” Hospital, Tivoli, Italy
ⁿHumanitas Clinical and Research CentereIRCCS, Department of Urology, Rozzano, Italy
^oDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
^pDepartment of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
^qDepartment of Diagnostic Imaging and Interventional Radiology, University of Rome “Tor Vergata”, Rome, Italy
^rDepartment of Interventional Radiology, Pesenti-Fenaroli Hospital-ASST Bergamo Est, Alzano Lombardo, Italy
^sDepartment of Urology, University of Siena, Siena, Italy
^tSwiss International Prostate Center, Geneva, Switzerland
^uClinique Générale Beaulieu, Geneva, Switzerland
^vDepartment of Urology, University of Catania, Italy
^wDepartment of Urology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
^xLyx Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain
^yDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy
^zDepartment of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
^aaDepartment of Radiology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
^abDepartment of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
^acDepartment of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
^adFlorida Healthcare Specialist, Urology and Minimally Invasive Surgery, Florida Cancer Specialist and Research Institute, Vero Beach, FL, USA
^aeDepartment of Surgery, Division of Urology and Gynecology, Sebastian River Medical Center, Sebastian, FL, USA
^afDepartment of Urology, Molinette Hospital, University of Torino School of Medicine, Turin, Italy
^agUrology Unit, Santa Rita Clinic, Avellino, Italy
^ahDepartment of Urology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
^aiDepartment of Urology, Policlinico di Bari, Bari, Italy

Abstract
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Abstract

Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser^® (Echolaser^® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method.

Methods: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser^® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized.

Results: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser^® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser^® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations.

Conclusion: Echolaser^® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.

Key words： Transperineal laser ablation Prostate cancer Benign prostatic hyperplasia Delphi consensus

Received: 23 January 2023 Available online: 20 April 2024

Corresponding Authors: * E-mail address: marta.pezzoli@unifi.it (M. Pezzoli).

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	Articles by authors
	Andrea Cocci
	Marta Pezzoli
	Fernando Bianco
	Franco Blefari
	Pierluigi Bove
	Francois Cornud
	Gaetano De Rienzo
	Paolo Destefanis
	Danilo Di Trapani
	Alessandro Giacobbe
	Luca Giovanessi
	Antonino Laganà
	Giovanni Lughezzani
	Guglielmo Manenti
	Gianluca Muto
	Gianluigi Patelli
	Novello Pinzi
	Stefano Regusci
	Giorgio I. Russo
	Juan I.M. Salamanca
	Matteo Salvi
	Luigi Silvestri
	Fabrizio Verweij
	Eric Walser
	Riccardo G. Bertolo
	Valerio Iacovelli
	Alessandro Bertaccini
	Debora Marchiori
	Hugo Davila
	Pasquale Ditonno
	Paolo Gontero
	Gennaro Iapicca
	Theo M De Reijke
	Vito Ricapito
	Pierluca Pellegrini
	Andrea Minervini
	Sergio Serni
	Francesco Sessa

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Cite this article:

Andrea Cocci,Marta Pezzoli,Fernando Bianco, et al. Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project[J]. Asian Journal of Urology, 2024, 11(2): 271-279.

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http://www.ajurology.com/EN/10.1016/j.ajur.2023.07.001 OR http://www.ajurology.com/EN/Y2024/V11/I2/271

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