Minimally invasive surgical techniques (MISTs) for benign prostatic hyperplasia: results from a Delphi consensus project to shed light on controversial topics.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Passarelli Federica, Castellani Daniele, Secco Silvia, Gacci Mauro, Sibona Mattia, Goumas Ioannis Kartalas, Manfredi Celeste, Ferrari Giovanni, Agrò Enrico Finazzi, Cocci Andrea, Miacola Carlos, Marenghi Carlo, D'Agostino Daniele, Arcaniolo Davide, Baldassarre Emanuele, Deho Federico, Palumbo Fabrizio, Gadda Franco, Sampogna Gianluca, Ruggera Lorenzo, Ferrando Luca, Preto Mirko, Schifano Nicolò, Capogrosso Paolo, De Lorenzis Elisa, Ismail Yasser Hussein Mohamed, Basadonna Ludovico Maria, Graps Giorgio, Longo Fabrizio, Salonia Andrea, Montanari Emanuele, Boeri Luca
Аннотация
METHODS: The Advisory Board developed 343 statements on 35 debated topics in the surgical management of BPH, each including multiple items rated on a 9-point Likert scale. The questionnaire was emailed to a Panel of 28 Italian urologists with 5-year experience in MISTs for the first round of voting. Statements that did not reach consensus were identified as "hot topics" and underwent a second round of voting during a Consensus conference, attended by all first-round participants, where the results were reviewed, debated, and re-voted upon anonymously.
RESULTS: The Panel agreed in defining TPLA, Rezum, iTIND, PAE and Urolift as MISTs, but no consensus was reached regarding Aquablation. Essential characteristics for being defined as MISTs were considered the feasibility in outpatient and one-night stay settings, minimal bleeding risk, early postoperative recovery of daily activities and a reduced impact on urinary continence and ejaculatory function. The Panel agreed that, compared to TURP, PAE, TPLA, Rezum, iTIND and Urolift were associated with lower postoperative bleeding rates, lower operative and hospitalization time, lower risk of postoperative incontinence; non consensus on these topics was achieved for Aquablation. The Panel agreed that flow rates after PAE, TPLA, iTIND and Urolift were worse than TURP, however, no consensus was achieved for Rezum and Aquablation. A high risk of retreatment was recognized for TPLA, iTIND and Urolift, but this was not the case for Rezum and Aquablation. iTIND and Urolift were deemed as the best options for prostate volume 30 ml, TPLA, Rezum and Aquablation for prostate volume 30-80 ml while no consensus was obtained for the best approach in larger volumes. No consensus was achieved for various aspects of postoperative management of MISTs.
CONCLUSIONS: Results from this Delphi project confirmed the lack of agreement on certain topics related to MISTs for BPH including the ideal treatment for large prostate volumes, functional outcomes and postoperative management.