Ultrasound-guided Transperineal Prostate Thermal Ablation (TPTA) for BPH: Feasibility of a Novel Outpatient procedure using Radiofrequency Ablation

Sixteen patients (median age 69 y) with urinary symptoms secondary to BPH prospectively underwent TPTA. Under moderate sedation and endorectal transperineal US probe guidance (Canon Medical SystemsÒ, Japan), a bilateral perineal nerve block was made with 20 mL of 1% lidocaine. A 17G RFA needle with a 10 mm active tip (AmicaÒ, Italy) was inserted in the enlarged internal gland. The needle was positioned within pre-defined safety parameters that were distance to the urethra and bladder superior to 8 and 15 mm, respectively. RF thermal ablation was initiated using 130W, and after characteristic US real-time tissue changes, the needle was slowly pulled back towards the prostatic apex using the moving shot technique. The needle was then repositioned to ablate more than 80% of the internal gland and preserve periurethral and bladder inferior wall tissue. Both prostatic sides were treated in the same session. Five minutes after RFA ablation, a contrast-enhanced ultrasound (CEUS) was performed after Sonovue® injection to assess adequate devascularization of the internal gland. If necessary, RF was reinserted to treat enhancing residual enhancing areas. The primary endpoints were the technical success and safety of TPTA. Secondary endpoints included International Prostate Symptom Score (IPSS), Quality of Life (QoL), peak urinary flow rate (Q _max), post-void residual (PVR), intravesical prostatic protrusion (IPP), PSA, and prostatic volume at 3 months. Shapiro Wilk, Student's t-test, and Wilcoxon Matched Pairs were used.

Results:

All procedures were technically successful. Three patients had transient hemospermia, 1 had mild hematuria, and 1 had subcutaneous hematoma (Clavien-Dildo 1). All patients were discharged on the same day.  At three months follow-up, IPSS improved from 17.5 (14,0 – 29.8) to 4.0 (2.5 – 6.5), QoL from 4.3 ± 0.9 to 1.2 ± 0.5, Q _max from 8.2 ± 2.0 to 15.9 ± 1.8 mL/s, PVR from 29.0 (18.8 – 62.5) to 17.0 (10 – 24.3), IPP from 8.0 (1.3 – 22.3) to 2.0 mm (0 – 10.3), PSA from 7,1 (2.8 – 9.2) to 2.65 ng/dL (1.11 – 4.65), and mean prostate volume from 109.9 ± 48.6 to 68.9 ± 29.4 mL. All these parameters were statistically significant (p< 0.001).

Conclusion: TPTA is feasible and safe in the treatment of BPH, providing significant clinical results at 3 months.