Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project.

Objective: 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. Methods: 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. Results: 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. Conclusion: Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.

Estimated glomerular filtration rate, renal scan and volumetric assessment of the kidney before and after partial nephrectomy: a review of the current literature.

INTRODUCTION: The best method for assessing renal function after partial nephrectomy (PN) continues to be a matter of debate. Early studies evaluated kidney function by measuring serum creatinine (sCr) and/or the estimated glomerular filtration rate (eGFR), potentially underestimating the contribution of the contralateral kidney in masking alterations in renal function. Since then, researchers have studied the operated renal unit with the aid of nuclear renal scans (RS). However, taking into consideration the importance of the amount of renal parenchyma spared or sacrificed during PN, many novel methods have been proposed for determining kidney volume before and after PN. This review presents a critical analysis of the literature concerning renal function assessment using eGFR, renal scan and volumetric methods before and after PN. EVIDENCE ACQUISITION: The literature review was carried out using the Pubmed database and the keywords "eGFR", "renal scan" and "volumetric assessment" in combination with "partial nephrectomy" or "nephron-sparing surgery". The search was limited to English language articles published between June 2006 and June 2016. EVIDENCE SYNTHESIS: Of the available formulas, the Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease equations should be used as they provide the best estimation of GFR. MAG3 RS is the most widely used method in current practice, presenting several distinct advantages. According to studies on volumetric assessment, as a general rule, renal tumors should be removed with resection of a thin rim of healthy parenchyma or by enucleation following the tumor pseudocapsule plane, as a histologic tumor-free resection margin, irrespective of the width of the margin, is sufficient to achieve local control during PN. There are no clear recommendations regarding the best modality to use. CONCLUSIONS: The use of serum creatinine alone should be avoided. The use of glomerular filtration rate, as estimated by means of available formulas, could be a viable option. If available, a nuclear RS should be adopted, whilst taking into account the limitations of this imaging methodology. Volumetric assessment continues to lack certainty. To date, no single proposed method for volumetric assessment appears to be superior above the others.