Ultrasound-guided Transperineal Prostate Thermal Ablation (TPTA) for Benign Prostatic Hyperplasia: Feasibility of an Outpatient Procedure using Radiofrequency Ablation

Thiago Franchi Nunes; Rafael Dahmer Rocha; Bibiana Ruiz Wehling Ilgenfritz; Flávio Scavone Stefanini; Vinicius Adami Vayego Fornazari; Guilherme Cayres Mariotti; Publio Cesar Cavalcante Viana; Rodrigo Gobbo Garcia; Hugo Alexandre Socrates de Castro; Denis Szejnfeld

doi:10.1007/s00270-024-03958-9

Ultrasound-guided Transperineal Prostate Thermal Ablation (TPTA) for Benign Prostatic Hyperplasia: Feasibility of an Outpatient Procedure using Radiofrequency Ablation

Cardiovasc Intervent Radiol. 2025 Jan 9. doi: 10.1007/s00270-024-03958-9. Online ahead of print.

Affiliations

¹ Department of Radiology, Universidade Federal de São Paulo (UNIFESP), Rua Dr. Ovidio Pires de Campos, 75, Cerqueira César, São Paulo, SP, 05403-010, Brazil. [email protected].
² Interventix, Rua Dr. Antônio Alves Arantes, 398, Chácara Cachoeira, Campo Grande, MS, 79040-720, Brazil. [email protected].
³ , Campo Grande, MS, Brazil. [email protected].
⁴ Instituto Dahmer Rocha, Rua Orestes Guimarães, 814, América, Joinville, SC, 89204-060, Brazil.
⁵ School of Medicine, Universidade de Araraquara (UNIARA), Rua Carlos Gomes, 1338, Centro, Araraquara, SP, 14801-340, Brazil.
⁶ Interventix, Rua Dr. Antônio Alves Arantes, 398, Chácara Cachoeira, Campo Grande, MS, 79040-720, Brazil.
⁷ Instituto Médico RAINTER, Avenida Ibirapuera, 2907, Conjuntos 901 e 902, Moema, São Paulo, SP, 04029-200, Brazil.
⁸ Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701, MorumbiSão Paulo, SP, 05652-900, Brazil.
⁹ Instituto Do Câncer Do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP, 01246-000, Brazil.
¹⁰ Department of Radiology, Universidade Federal de São Paulo (UNIFESP), Rua Dr. Ovidio Pires de Campos, 75, Cerqueira César, São Paulo, SP, 05403-010, Brazil.

PMID: 39789257
DOI: 10.1007/s00270-024-03958-9

Abstract

Purpose: To evaluate the feasibility, safety, and short-term (3-month) results of transperineal prostate thermal ablation (TPTA) as a minimally invasive outpatient treatment for benign prostatic hyperplasia (BPH).

Materials and methods: A prospective nonrandomized study of 25 patients with lower urinary tract symptoms secondary to BPH seeking care at 2 interventional radiology centers between March and July 2024. TPTA was performed using a 17G radiofrequency needle with a 10-mm active tip under unconscious sedation combined with bilateral perineal and periprostatic nerve blocks. The primary outcome measure was technical success, defined as successful bilateral ablation of the prostate transition zone. Secondary outcome measures included changes of international prostate symptom score (IPSS), quality of life (QoL), prostate volume, intravesical prostatic protrusion (IPP), prostate-specific antigen (PSA), post-void residual volume (PVR), maximum urinary flow rate (Qmax), and need for BPH medical therapy at 3 months relative to baseline.

Results: All procedures were technically successful (100%). The median patient age was 69.4 years (IQR 54-74), and all were discharged within 3 h of the end of the procedure. Sixteen patients (64.0%) were discharged without a urinary catheter, and 6 patients (24.0%) reported mild complications. At 3-month follow-up, there were significant reductions in IPSS (79.1%), QoL score (70.3%), prostate volume (36.9%), IPP (70.8%), PSA (54.7%), and PVR (51.1%), whereas Qmax increased significantly (102.3%). Twenty-four patients (96.0%) reported discontinuation of medical therapy after TPTA.

Conclusion: Ultrasound-guided TPTA using radiofrequency ablation is feasible and safe in the outpatient setting, with significant clinical improvements after 3 months of the procedure.

Level of evidence: Level 3 [non-randomized prospective cohort study].

Keywords: Ablation; Benign prostatic hyperplasia; Ejaculation sparing; Guided transperineal; Lower urinary tract symptoms; Minimally invasive surgical techniques; Minimally invasive treatments; Outpatient; Prostate; Radiofrequency; Ultra; Ultrasound.