We aimed to review the current evidence on surgical and functional outcomes of Transperineal Laser Ablation for LUTS due to BPH. A comprehensive review of the English-language literature was performed using the MEDLINE and Web of Science databases until 1 August 2022, aiming to select studies evaluating TPLA for the treatment of LUTS due to BPH. Additional records were found from Google Scholar. Data were extracted and summarized in Tables. An appropriate form was used for qualitative data synthesis. Seven studies were included in the review, with all being single arm, non-comparative studies. In all studies, functional outcomes were evaluated with uroflowmetry parameters and validated questionnaires, showing a promising effectiveness at short- and mid-term follow-up. There is a lack of standardized pathways for preoperative assessment of patients suitable for TPLA, and even the technique itself has been reported with a few nuances. A good safety profile has been reported by all the authors. Although promising results have been reported by different groups, selection criteria for TPLA and few technical nuances regarding the procedure were found to be heterogeneous across the published series that should be standardized in the future. Further research is needed to confirm these findings.

Background: The aim of our study is to evaluate the prevalence and predictive factors of short- (30 d) and mid-term continence in a contemporary cohort of patients treated with robotic-assisted laparoscopic prostatectomy (RALP) without any posterior or anterior reconstruction at our referral academic center. Methods: Data from patients undergoing RALP between January 2017 and March 2021 were prospectively collected. RALP was performed by three highly experienced surgeons following the principles of the Montsouris technique, with a bladder-neck-sparing intent and maximal preservation of the membranous urethra (if oncologically safe) without any anterior/posterior reconstruction. (Self-assessed urinary incontinence (UI) was defined as the need of one or more pads per die (excluding the need for a safety pad/die. Univariable and multivariable logistic regression analysis was used to assess the independent predictors of early incontinence among routinely collected patient- and tumor-related variables). Results: A total of 925 patients were included; of these, 353 underwent RALP (38.2%) without nerve-sparing intent. The median patient age and BMI were 68 years (IQR 63–72) and 26 (IQR 24.0–28.0), respectively. Overall, 159 patients (17.2%) reported early (30 d) incontinence. In multivariable analysis adjusting for patient- and tumor-related features, a non-nerve-sparing procedure (OR: 1.57 [95% CI: 1.03–2.59], p = 0.035) was independently associated with the risk of urinary incontinence in the short-term period, while the absence of cardiovascular diseases before surgery (OR: 0.46 [95% CI: 0.320.67], p ≤ 0.01) was a protective factor for this outcome. At a median follow-up of 17 months (IQR 10–24), 94.5% of patients reported to be continent. Conclusions: In experienced hands, most patients fully recover urinary continence after RALP at mid-term follow-up. On the contrary, the proportion of patients who reported early incontinence in our series was modest but not negligible. The implementation of surgical techniques advocating anterior and/or posterior fascial reconstruction might improve the early continence rate in candidates for RALP.

Objective: To explore the impact of supine retroperitoneal single-port robot-assisted partial nephrectomy with lower anterior access on perioperative ventilatory, cardiovascular, and pain-related outcomes compared to a cohort of patients treated with single-port robot-assisted retroperitoneal or transperitoneal partial nephrectomy with standard flank patient positioning. Materials and Methods: Clinical and surgical data of all consecutive patients treated with single-port robot-assisted partial nephrectomy between March 2019 and January 2024 were prospectively collected and retrospectively analyzed. Specific same-day-discharge guidelines were applied to all cases. Failed same-day discharge was defined as the presence of early (<90 days) perioperative complications or the absence of opioid-free postoperative recovery. Results: Overall, 105 consecutive patients treated with single-port robot-assisted partial nephrectomy were analyzed. No differences emerged in baseline features. Peak inspiratory pressure and plateau pressure changes were significantly lower in the supine retroperitoneal lower anterior access group from the time of CO₂ insufflation throughout every 30-min operative setpoint assessment (p = 0.02, p = 0.03, and p = 0.02, respectively). The transperitoneal group showed significantly higher values of mean, systolic, and diastolic blood pressure compared to retroperitoneal approaches. The supine lower anterior access group also showed significantly lower non-surgical operative room time, perioperative opioid administration, and postoperative median VAS pain score. Conclusions: The adoption of supine lower anterior access improved perioperative ventilatory, cardiovascular, and pain-related outcomes, also optimizing operating room efficiency. Further multicenter series with longer follow-ups are still needed to validate our preliminary results.

Despite transrectal prostate biopsy (TRPB) being still widespread globally, the EAU Guidelines strongly recommend the transperineal approach, due to the reported lower infectious risk. Our study aims to evaluate the impact of a standardized clinical pathway for TRPB on post-operative complications. We prospectively collected data from all patients undergoing mpMRI-targeted TRPB at our Academic Centre from January 2020 to December 2022. All patients followed a standardized, structured multistep pathway. Post-procedural complications were collected and classified according to the Clavien–Dindo (CD) Classification. Among 458 patients, post-procedural adverse events were reported by 203 (44.3%), of which 161 (35.2%) experienced CD grade 1 complications (hematuria [124, 27.1%], hematochezia [22, 4.8%], hematospermia [14, 3.1%], or a combination [20, 4.4%]), and 45 (9.0%) reported CD grade 2 complications (acute urinary retention or hematuria needing catheterization, as well as urinary tract infections, of which 2 cases required hospitalization). No major complications, including sepsis, were observed. At uni- and multivariable analysis, age > 70 years and BMI > 25 kg/ m² for patients were identified as predictors of post-operative complications. The results of our study confirm that TRPB is a safe and cost-effective procedure with a low risk of severe adverse events in experienced hands and following a standardized pathway.

This chapter provides a comprehensive overview of Transperineal Laser Ablation of the prostate (TPLA™) as a therapeutic option for Benign Prostatic Hyperplasia (BPH). BPH is a prevalent condition among aging men, characterized by non-cancerous enlargement of the prostate gland, leading to lower urinary tract symptoms (LUTS) and impacting quality of life. TPLA™ emerges as a minimally invasive technique leveraging the precision of laser energy to induce coagulative necrosis in targeted prostatic tissue, thereby reducing prostate volume and alleviating symptoms. The chapter systematically reviews the procedural aspects of TPLA™, including patient selection criteria, preoperative preparation, and step-by-step surgical technique. Clinical outcomes are discussed, with a focus on symptom relief, improvement in urinary flow rates, and reduction in prostate volume. Furthermore, the safety profile of TPLA™ is examined, documenting the incidence and management of potential complications. In conclusion, TPLA™ represents a promising addition to the therapeutic armamentarium for BPH, offering a balance of efficacy and safety, ensuring high rates of preservation of sexual function.