Mp27-20 New Minimally Invasive Techniques Versus Gold Standard Approach for Middle Volume (30-80 Ml) Prostates: A Multicentre Prospective Randomized Study

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP27)1 May 2024MP27-20 NEW MINIMALLY INVASIVE TECHNIQUES VERSUS GOLD STANDARD APPROACH FOR MIDDLE VOLUME (30-80 ML) PROSTATES: A MULTICENTRE PROSPECTIVE RANDOMIZED STUDY Antonio Luigi Pastore, Onofrio Antonio Rera, Manfredi Bruno Sequi, Alice Antonioni, Fabio Maria Valenzi, Paolo Pietro Suraci, Silvio Scalzo, Damiano Graziani, Filippo Gianfrancesco, Giorgio Martino, Giuseppe Candita, Andrea Fuschi, Yazan Al Salhi, Cosimo De Nunzio, Riccardo Lombardo, Alessandro Sciarra, Francesco Del Giudice, Raffaele Balsamo, Francesco Uricchio, and Antonio Carbone Antonio Luigi PastoreAntonio Luigi Pastore , Onofrio Antonio ReraOnofrio Antonio Rera , Manfredi Bruno SequiManfredi Bruno Sequi , Alice AntonioniAlice Antonioni , Fabio Maria ValenziFabio Maria Valenzi , Paolo Pietro SuraciPaolo Pietro Suraci , Silvio ScalzoSilvio Scalzo , Damiano GrazianiDamiano Graziani , Filippo GianfrancescoFilippo Gianfrancesco , Giorgio MartinoGiorgio Martino , Giuseppe CanditaGiuseppe Candita , Andrea FuschiAndrea Fuschi , Yazan Al SalhiYazan Al Salhi , Cosimo De NunzioCosimo De Nunzio , Riccardo LombardoRiccardo Lombardo , Alessandro SciarraAlessandro Sciarra , Francesco Del GiudiceFrancesco Del Giudice , Raffaele BalsamoRaffaele Balsamo , Francesco UricchioFrancesco Uricchio , and Antonio CarboneAntonio Carbone View All Author Informationhttps://doi.org/10.1097/01.JU.0001009400.86696.a2.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transurethral resection of prostate (TURP) is still considered the gold standard therapy for mid volume prostate glands (30-80 ml). Lately other minimally invasive treatments have been introduced with the aim to reduce TURP related morbidity, such as: convective water vapor energy (Rezum) and water-jet ablation (Aquablation). The aim of this study is to compare the perioperative and functional outcomes between TURP and two new minimally invasive techniques METHODS: Patients with non-neurogenic Lower Urinary Tract Symptoms (LUTS) secondary to mid volume benign prostatic obstruction (30-80 ml), were prospectively randomized to three surgical approaches. All patients were preoperatively evaluated with digital rectal examination (DRE), PSA, prostate volume was evaluated by trans abdominal ultrasound. Preoperatively, 6- and 9-months postop all subjects were investigated with: Uroflowmetry (Qmax and Qave) with postvoid residual (PVR), International Prostatic Symptoms Score (IPSS), Male Sexual Health Questionnaire (MSHQ) and International Index of Erectile Function (IIEF-5). RESULTS: 312 patients with mean age of 63.6 years old (56-74 years) were prospectively randomized to the following treatment groups: 92 subjects underwent Rezum (group A), 108 patients Aquablation (group B), and 112 patients bipolar TURP (group C). Postoperative IPSS resulted lower in patients underwent TURP and AQUABEAM (2 and 2, respectively) than Rezum (5; p<0.001). Postoperative IIEF5 mean scores significantly increased in groups A and B (26 and 25, respectively) than in group C (17, p<0.001). The antegrade ejaculation was spared in all Rezum and Aquablation subjects. TURP group reported mean flowmetry parameters significantly increased when compared to Aquabeam and Rezum groups (mean Qmax-Qave 19.4-10.6, 17.4-9.3, and 16.9-8.7 ml/sec, respectively p<.005). Operating time and length of hospital stay were longer after TURP (respectively 56.9 min, 3 days) when compared to the other two groups (2.4 min, 0.6 days; 5.2 min, 1 day, in group A and B, respectively). The mean estimated blood loss (evaluated as postoperative drop in Hb) was significantly greater in group C (DHb 1.2 mg/dl) than in the other two groups (DHb 0.1 mg/dl in both groups, p<.005). CONCLUSIONS: Postoperative outcomes were more effective in the Aquabeam and Rezum groups in terms of sexual function and overall satisfaction, especially when evaluating the antegrade ejaculation sparing. Source of Funding: Dey A, Mamoulakis C, Hasan N, Yuan Y, Shakil A, Omar MI. Emerging Technologies for the Surgical Management of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Obstruction. A Systematic Review. Eur Urol Focus. 2023 Sep 21:S2405-4569(23)00201-8. doi: 10.1016/j.euf.2023.09.003. Epub ahead of print. PMID: 37741783 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e431 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Antonio Luigi Pastore More articles by this author Onofrio Antonio Rera More articles by this author Manfredi Bruno Sequi More articles by this author Alice Antonioni More articles by this author Fabio Maria Valenzi More articles by this author Paolo Pietro Suraci More articles by this author Silvio Scalzo More articles by this author Damiano Graziani More articles by this author Filippo Gianfrancesco More articles by this author Giorgio Martino More articles by this author Giuseppe Candita More articles by this author Andrea Fuschi More articles by this author Yazan Al Salhi More articles by this author Cosimo De Nunzio More articles by this author Riccardo Lombardo More articles by this author Alessandro Sciarra More articles by this author Francesco Del Giudice More articles by this author Raffaele Balsamo More articles by this author Francesco Uricchio More articles by this author Antonio Carbone More articles by this author Expand All Advertisement PDF downloadLoading ...