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.
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.
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.
Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.
Asian journal of urology. 2023 Jul 11 [Epub]
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
Department of Urology, Careggi Hospital, University of Florence, Florence, Italy., Urology Section, University of Florence, Florence, Italy., Urological Research Network, Miami, FL, USA., Urology Section, Prato Hospital, Prato, Italy., Torvergata Oncoscience Research Centre of Excellence, TOR, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy., Department of Radiology, Hôpital Cochin, Paris Descartes University, Paris, France., Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy., Unit of Urology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy., Urology Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy., Department of Urology, Humanitas Gradenigo Hospital, Turin, Italy., Urology Unit, Surgical Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy., Departement of Urology, "S.Giovanni Evangelista" Hospital, Tivoli, Italy., Humanitas Clinical and Research Center-IRCCS, Department of Urology, Rozzano, Italy., Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy., Department of Interventional Radiology, Pesenti-Fenaroli Hospital-ASST Bergamo Est, Alzano Lombardo, Italy., Department of Urology, University of Siena, Siena, Italy., Swiss International Prostate Center, Geneva, Switzerland., Department of Urology, University of Catania, Italy., Department of Urology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain., Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy., Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy., Department of Radiology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA., Department of Urology, San Carlo di Nancy Hospital, Rome, Italy., Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Florida Healthcare Specialist, Urology and Minimally Invasive Surgery, Florida Cancer Specialist and Research Institute, Vero Beach, FL, USA., Department of Urology, Molinette Hospital, University of Torino School of Medicine, Turin, Italy., Urology Unit, Santa Rita Clinic, Avellino, Italy., Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands., Department of Urology, Policlinico di Bari, Bari, Italy.