Trifecta outcomes to assess the feasibility of local anesthesia for benign prostate hyperplasia minimally invasive surgical treatments

Alberto Olivero; Sinan Khadhouri; Erika Palagonia; Paolo Dell'Oglio; Stefano Tappero; Barend Dreyer; Aldo Massimo Bocciardi; Alberto Caviglia; Antonio Galfano; Feras Al Jaafari; Bhaskar K Somani; Amelia Pietropaolo; Silvia Secco

doi:10.4103/ua.ua_41_25

Trifecta outcomes to assess the feasibility of local anesthesia for benign prostate hyperplasia minimally invasive surgical treatments

Alberto Olivero, Sinan Khadhouri, Erika Palagonia, Paolo Dell'Oglio, Stefano Tappero, Barend Dreyer, Aldo Massimo Bocciardi, Alberto Caviglia, Antonio Galfano, Feras Al Jaafari, Bhaskar K Somani, Amelia Pietropaolo, Silvia Secco

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Minimally invasive surgical treatments (MISTs) are many promising approaches for the management of benign prostate hyperplasia (BPH) that might be performed under local anesthesia (LA) and have same-day discharge. To address the feasibility and efficacy of LA for BPH-MIST, a specific trifecta was conceptualized and tested: (1) no intraoperative complications, (2) reduced intraoperative pain, and (3) same-day discharge.

Materials and Methods: We prospectively collected data from patients who underwent Rezum, Urolift, and iTIND treatments from January 01, 2023, to February 28, 2024, on an international database. All the patients received a local administration of two anesthetic gels in the urethra before the procedure; selected patients, in addition, received a transperineal anesthetic injection in the periprostatic space or transurethrally with a Schelin Catheter (SC) injection directly in the prostatic lobes. Reduced intraoperative pain was defined as <5 on the visual analogue scale (VAS range: 0-10).

Results: Overall, 156 patients were included in the study. Median age was 63.5 (interquartile range [IQR]: 56-70) years. Eleven patients (7.0%) had diabetes, and 29 (18.6%) received anticoagulant medication. Ten patients (6.4%) had indwelling catheters. The median prostate size was 45 ml (IQR: 34-60). Forty-eight patients underwent Urolift (30.8%), 70 (44.8%) Rezum, and 38 (24.4%) iTIND. The transperineal block and the SC were used in 21 patients (13.5%) and 32 (20.5%) patients, respectively, with 103 (66%) patients receiving only the anesthetic gels in the urethra. Performing MIST in pure LA achieved the trifecta outcome in 122 patients (78.2%). Six patients (3.8%) had intraoperative complications. One hundred and thirty patients (83.3%) experienced reduced intraoperative pain (<5 on VAS). One hundred and 47 (94.2%) patients were discharged on the same day of the procedure.

Conclusions: LA for MIST in BPH is feasible, with excellent success rates and reduced pain, as trifecta outcomes were achieved.

Original language	English
Pages (from-to)	233-238
Number of pages	6
Journal	Urology annals
Volume	17
Issue number	4
Early online date	17 Oct 2025
DOIs	https://doi.org/10.4103/ua.ua_41_25
Publication status	Published - Oct 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Benign prostate hyperplasia
i-TIND
Local anesthesia
Minimally invasive surgical treatments
Rezum
Schelin catheter
Urolift

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Copyright © 2025 Urology Annals | Published by Wolters Kluwer - Medknow. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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Olivero, A., Khadhouri, S., Palagonia, E., Dell'Oglio, P., Tappero, S., Dreyer, B., Bocciardi, A. M., Caviglia, A., Galfano, A., Al Jaafari, F., Somani, B. K., Pietropaolo, A., & Secco, S. (2025). Trifecta outcomes to assess the feasibility of local anesthesia for benign prostate hyperplasia minimally invasive surgical treatments. Urology annals, 17(4), 233-238. https://doi.org/10.4103/ua.ua_41_25

@article{ca4b32a18f50406db66a34b93528efbc,

title = "Trifecta outcomes to assess the feasibility of local anesthesia for benign prostate hyperplasia minimally invasive surgical treatments",

abstract = "Background: Minimally invasive surgical treatments (MISTs) are many promising approaches for the management of benign prostate hyperplasia (BPH) that might be performed under local anesthesia (LA) and have same-day discharge. To address the feasibility and efficacy of LA for BPH-MIST, a specific trifecta was conceptualized and tested: (1) no intraoperative complications, (2) reduced intraoperative pain, and (3) same-day discharge.Materials and Methods: We prospectively collected data from patients who underwent Rezum, Urolift, and iTIND treatments from January 01, 2023, to February 28, 2024, on an international database. All the patients received a local administration of two anesthetic gels in the urethra before the procedure; selected patients, in addition, received a transperineal anesthetic injection in the periprostatic space or transurethrally with a Schelin Catheter (SC) injection directly in the prostatic lobes. Reduced intraoperative pain was defined as <5 on the visual analogue scale (VAS range: 0-10).Results: Overall, 156 patients were included in the study. Median age was 63.5 (interquartile range [IQR]: 56-70) years. Eleven patients (7.0\%) had diabetes, and 29 (18.6\%) received anticoagulant medication. Ten patients (6.4\%) had indwelling catheters. The median prostate size was 45 ml (IQR: 34-60). Forty-eight patients underwent Urolift (30.8\%), 70 (44.8\%) Rezum, and 38 (24.4\%) iTIND. The transperineal block and the SC were used in 21 patients (13.5\%) and 32 (20.5\%) patients, respectively, with 103 (66\%) patients receiving only the anesthetic gels in the urethra. Performing MIST in pure LA achieved the trifecta outcome in 122 patients (78.2\%). Six patients (3.8\%) had intraoperative complications. One hundred and thirty patients (83.3\%) experienced reduced intraoperative pain (<5 on VAS). One hundred and 47 (94.2\%) patients were discharged on the same day of the procedure.Conclusions: LA for MIST in BPH is feasible, with excellent success rates and reduced pain, as trifecta outcomes were achieved.",

keywords = "Benign prostate hyperplasia, i-TIND, Local anesthesia, Minimally invasive surgical treatments, Rezum, Schelin catheter, Urolift",

author = "Alberto Olivero and Sinan Khadhouri and Erika Palagonia and Paolo Dell'Oglio and Stefano Tappero and Barend Dreyer and Bocciardi, \{Aldo Massimo\} and Alberto Caviglia and Antonio Galfano and \{Al Jaafari\}, Feras and Somani, \{Bhaskar K\} and Amelia Pietropaolo and Silvia Secco",

year = "2025",

month = oct,

doi = "10.4103/ua.ua\_41\_25",

language = "English",

volume = "17",

pages = "233--238",

journal = "Urology annals",

issn = "0974-7796",

publisher = "Wolters Kluwer Medknow Publications",

number = "4",

}

Olivero, A, Khadhouri, S, Palagonia, E, Dell'Oglio, P, Tappero, S, Dreyer, B, Bocciardi, AM, Caviglia, A, Galfano, A, Al Jaafari, F, Somani, BK, Pietropaolo, A & Secco, S 2025, 'Trifecta outcomes to assess the feasibility of local anesthesia for benign prostate hyperplasia minimally invasive surgical treatments', Urology annals, vol. 17, no. 4, pp. 233-238. https://doi.org/10.4103/ua.ua_41_25

TY - JOUR

T1 - Trifecta outcomes to assess the feasibility of local anesthesia for benign prostate hyperplasia minimally invasive surgical treatments

AU - Olivero, Alberto

AU - Khadhouri, Sinan

AU - Palagonia, Erika

AU - Dell'Oglio, Paolo

AU - Tappero, Stefano

AU - Dreyer, Barend

AU - Bocciardi, Aldo Massimo

AU - Caviglia, Alberto

AU - Galfano, Antonio

AU - Al Jaafari, Feras

AU - Somani, Bhaskar K

AU - Pietropaolo, Amelia

AU - Secco, Silvia

PY - 2025/10

Y1 - 2025/10

N2 - Background: Minimally invasive surgical treatments (MISTs) are many promising approaches for the management of benign prostate hyperplasia (BPH) that might be performed under local anesthesia (LA) and have same-day discharge. To address the feasibility and efficacy of LA for BPH-MIST, a specific trifecta was conceptualized and tested: (1) no intraoperative complications, (2) reduced intraoperative pain, and (3) same-day discharge.Materials and Methods: We prospectively collected data from patients who underwent Rezum, Urolift, and iTIND treatments from January 01, 2023, to February 28, 2024, on an international database. All the patients received a local administration of two anesthetic gels in the urethra before the procedure; selected patients, in addition, received a transperineal anesthetic injection in the periprostatic space or transurethrally with a Schelin Catheter (SC) injection directly in the prostatic lobes. Reduced intraoperative pain was defined as <5 on the visual analogue scale (VAS range: 0-10).Results: Overall, 156 patients were included in the study. Median age was 63.5 (interquartile range [IQR]: 56-70) years. Eleven patients (7.0%) had diabetes, and 29 (18.6%) received anticoagulant medication. Ten patients (6.4%) had indwelling catheters. The median prostate size was 45 ml (IQR: 34-60). Forty-eight patients underwent Urolift (30.8%), 70 (44.8%) Rezum, and 38 (24.4%) iTIND. The transperineal block and the SC were used in 21 patients (13.5%) and 32 (20.5%) patients, respectively, with 103 (66%) patients receiving only the anesthetic gels in the urethra. Performing MIST in pure LA achieved the trifecta outcome in 122 patients (78.2%). Six patients (3.8%) had intraoperative complications. One hundred and thirty patients (83.3%) experienced reduced intraoperative pain (<5 on VAS). One hundred and 47 (94.2%) patients were discharged on the same day of the procedure.Conclusions: LA for MIST in BPH is feasible, with excellent success rates and reduced pain, as trifecta outcomes were achieved.

AB - Background: Minimally invasive surgical treatments (MISTs) are many promising approaches for the management of benign prostate hyperplasia (BPH) that might be performed under local anesthesia (LA) and have same-day discharge. To address the feasibility and efficacy of LA for BPH-MIST, a specific trifecta was conceptualized and tested: (1) no intraoperative complications, (2) reduced intraoperative pain, and (3) same-day discharge.Materials and Methods: We prospectively collected data from patients who underwent Rezum, Urolift, and iTIND treatments from January 01, 2023, to February 28, 2024, on an international database. All the patients received a local administration of two anesthetic gels in the urethra before the procedure; selected patients, in addition, received a transperineal anesthetic injection in the periprostatic space or transurethrally with a Schelin Catheter (SC) injection directly in the prostatic lobes. Reduced intraoperative pain was defined as <5 on the visual analogue scale (VAS range: 0-10).Results: Overall, 156 patients were included in the study. Median age was 63.5 (interquartile range [IQR]: 56-70) years. Eleven patients (7.0%) had diabetes, and 29 (18.6%) received anticoagulant medication. Ten patients (6.4%) had indwelling catheters. The median prostate size was 45 ml (IQR: 34-60). Forty-eight patients underwent Urolift (30.8%), 70 (44.8%) Rezum, and 38 (24.4%) iTIND. The transperineal block and the SC were used in 21 patients (13.5%) and 32 (20.5%) patients, respectively, with 103 (66%) patients receiving only the anesthetic gels in the urethra. Performing MIST in pure LA achieved the trifecta outcome in 122 patients (78.2%). Six patients (3.8%) had intraoperative complications. One hundred and thirty patients (83.3%) experienced reduced intraoperative pain (<5 on VAS). One hundred and 47 (94.2%) patients were discharged on the same day of the procedure.Conclusions: LA for MIST in BPH is feasible, with excellent success rates and reduced pain, as trifecta outcomes were achieved.

KW - Benign prostate hyperplasia

KW - i-TIND

KW - Local anesthesia

KW - Minimally invasive surgical treatments

KW - Rezum

KW - Schelin catheter

KW - Urolift

U2 - 10.4103/ua.ua_41_25

DO - 10.4103/ua.ua_41_25

M3 - Article

C2 - 41229574

SN - 0974-7796

VL - 17

SP - 233

EP - 238

JO - Urology annals

JF - Urology annals

IS - 4

ER -

Trifecta outcomes to assess the feasibility of local anesthesia for benign prostate hyperplasia minimally invasive surgical treatments

Abstract

UN SDGs

Keywords

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