3-T MRI and clinical validation of ultrasound-guided transperineal laser ablation of benign prostatic hyperplasia

Abstract

Background: Transperineal laser ablation (TPLA) of the prostate is a novel, mini-invasive option for men with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH). Our aim was to assess the impact of ultrasound-guided TPLA regarding urodynamic improvement and sexual function, monitoring clinical data, postprocedural complications and imaging findings at 3-T multiparametric magnetic resonance imaging.

Methods: Forty-four patients aged ≥ 50 affected with moderate to severe LUTS (International Prostate Symptoms score ≥ 12) due to benign prostatic obstruction and refractoriness, intolerance or poor compliance to medical therapies underwent US-guided TPLA between May 2018 and February 2020. Clinical measurements included PSA, uroflowmetry, sexual function assessment (using the International Index of Erectile Function and Male Sexual Health Questionnaire-Ejaculatory Dysfunction short form) and quality of life questionnaire. Adverse events were evaluated using the Clavien-Dindo scale. Volume changes were measured by MRI and automatic segmentation software during 1-year follow-up. Registration: NCT04044573 - May 5th, 2018, https://www.clinicaltrials.gov RESULTS: MRI assessed the changes over time with a 53% mean reduction of adenoma volume and 71% of the ablated area, associated with clinical and functional improvement and resolution of LUTS in all cases. Five of 44 patients (11.3%) had urinary blockage due to clots and required re-catheterisation for 2 weeks. The overall adverse event rate was 7%.

Conclusion: US-guided TPLA performed as a safe, manageable and effective treatment for LUTS. It could be considered an alternative effective mini-invasive procedure to standard treatments for BPH in the outpatient setting.

Keywords: Laser therapy; Lower urinary tract symptoms; Magnetic resonance imaging; Prostatic hyperplasia.

Conflict of interest statement

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

© 2021. The Author(s).

Figures

Fig. 1

a Transrectal ultrasound imaging of transperineal laser ablation with gas bubble formation during the procedure. b Power Doppler imaging with Doppler effect related to water molecule movement into the ablated tissue

Fig. 2

Large bilateral symmetrical bilobar adenoma in a 62-year-old patient before treatment, on magnetic resonance imaging T2-weighted sequences along the coronal (a) and axial (c) planes. The same sequences, along the coronal (b) and axial (d) planes, performed immediately after transperineal prostate laser ablation show only longitudinal linear hyperintensities (arrows) surrounded by hypointense elliptical-shaped charred tissue (arrowheads) at the site of laser fibre tracks. At this time, no signs of coagulative necrosis are yet visible

Fig. 3

Follow-up from month 3 to month 12 in the same patient shown in Figs. 1 and 2: T2-weighted sequences along coronal and axial planes. a, d Month 3: large bilateral and symmetrical necrotic cavitations (arrows); prostate volume 72 cc. b, e Month 6: Fluid-filled cavities are reabsorbed. Tracks from fibre applicators are slightly visible (arrowhead). Urethral morphology is preserved. Prostate volume is reduced by 30%. c, f Month 12: bilateral hypointense scar tissue is present (arrow). Prostate volume is reduced by 51%

Fig. 4

T2-weighted sequences along the axial (a) and sagittal (c) plane at month 12 after transperineal prostate laser ablation (TPLA) in a 70-year-old patient in comparison with the same sequences (b, d) in a 68-year-old patient 12 months after transurethral resection of the prostate (TURP). After TPLA, a horseshoe-shaped hyperintense fluid collection in the transitional gland is well emarginated by the prostate pseudocapsule. The urethra is visible as a hyperintense spot inside the solid stromal adenoma core with reduced compression from the hypertrophic central gland. Both bladder neck and urethra morphology are preserved and therefore bladder function and ejaculation are preserved as well. After transurethral resection of the prostate (TURP), the bladder neck is wedged into the surgical cavum. The urethra is no longer visible. Bladder function and ejaculation are impaired

Fig. 5

A representative case of automatic segmentation software analysis (Philips IntelliSpace Portal 7.0 Multi Modality Tumor Tracking) of fluid-filled postablation cavities and prostate volumetric trend on axial T2-weighted sequences in a 58-year-old patient between (from left to right) month 1, month 3, and month 12. The right necrotic cavity showed a volumetric reduction of 83.8% between month 1 and month 3 and an 88.8% reduction between month 3 and month 12. The volume of the left cavity showed a reduction of 80.8% between month 1 and month 3, becoming no longer detectable at month 12