Urologia · 2026
Redefining clinical success in minimally invasive surgery for BPH: A composite endpoint integrating ejaculatory function, urinary improvement, and safety metrics.
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Anceschi Umberto, Amparore Daniele, Minore Antonio, Tufano Antonio, Ferrando Luca, Ortenzi Michele, Checcucci Enrico, Siena Giampaolo, Cocci Andrea, Flammia Rocco Simone, Prata Francesco, Basile Salvatore, De Cillis Sabrina, Mastroianni Riccardo, Brassetti Aldo, Ferriero Maria Consiglia, Bove Alfredo Maria, Tuderti Gabriele, Ferrari Giovanni, Varvello Francesco, Pansadoro Vito, Minervini Andrea, Fiori Cristian, Porpiglia Francesco, Cindolo Luca, Simone Giuseppe
Аннотация
OBJECTIVES: Achieving both relief of urinary obstruction and preservation of ejaculatory function is a key goal of modern surgical management for benign prostatic hyperplasia (BPH). However, standardized definitions of success that integrate multiple clinical domains remain limited. This study introduces a composite definition of clinical success and explores its predictors using a multicenter dataset of minimally invasive, ejaculation-preserving procedures.
METHODS: Multi-institutional data were combined, including patients who underwent urethral-sparing robot-assisted simple prostatectomy (usRASP; n = 94), Aquablation (n = 95), or Rezum (n = 308). Complete clinical success (CSS) was defined as: (1) ⩾30% International Prostatic Symptoms Score (IPSS) reduction at 12-months; (2) preserved ejaculation, based on a positive response to the Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD Q3); and (3) absence of ⩾Grade III Clavien-Dindo complications. Partial clinical success (PCS) was defined as the achievement of any two of the three criteria. A multivariable logistic regression analysis identified independent predictors of CCS.
RESULTS: The final cohort included 497 patients. CCS rates were 66.0% (usRASP), 73.6% (Aquablation), and 68.8% (Rezum); PCS rates were 28.7%, 14.7%, and 20.1%, respectively. No significant differences were observed among groups for IPSS (p = 0.455), ejaculation rates (p = 0.07), or complication rates (p = 0.445). On multivariable analysis, prostate volume < 110 mL (OR 0.52; p = 0.034), higher MSHQ-EjD Q3 (OR 1.07; p < 0.001), and shorter catheterization time (OR 0.91; p = 0.02) independently predicted CCS at 1 year.
CONCLUSIONS: This composite endpoint offers a pragmatic and clinically relevant framework for evaluating success in minimally invasive BPH surgery. Its adoption may enhance cross-technique comparisons and inform individualized treatment strategies.
METHODS: Multi-institutional data were combined, including patients who underwent urethral-sparing robot-assisted simple prostatectomy (usRASP; n = 94), Aquablation (n = 95), or Rezum (n = 308). Complete clinical success (CSS) was defined as: (1) ⩾30% International Prostatic Symptoms Score (IPSS) reduction at 12-months; (2) preserved ejaculation, based on a positive response to the Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD Q3); and (3) absence of ⩾Grade III Clavien-Dindo complications. Partial clinical success (PCS) was defined as the achievement of any two of the three criteria. A multivariable logistic regression analysis identified independent predictors of CCS.
RESULTS: The final cohort included 497 patients. CCS rates were 66.0% (usRASP), 73.6% (Aquablation), and 68.8% (Rezum); PCS rates were 28.7%, 14.7%, and 20.1%, respectively. No significant differences were observed among groups for IPSS (p = 0.455), ejaculation rates (p = 0.07), or complication rates (p = 0.445). On multivariable analysis, prostate volume < 110 mL (OR 0.52; p = 0.034), higher MSHQ-EjD Q3 (OR 1.07; p < 0.001), and shorter catheterization time (OR 0.91; p = 0.02) independently predicted CCS at 1 year.
CONCLUSIONS: This composite endpoint offers a pragmatic and clinically relevant framework for evaluating success in minimally invasive BPH surgery. Its adoption may enhance cross-technique comparisons and inform individualized treatment strategies.