Image-guided, urethra-sparing transperineal radiofrequency ablation for benign prostatic hyperplasia: a prospective bicenter outpatient study
6 affiliations
- 1Interventix, Rua Dr. Antônio Alves Arantes, Campo Grande, Brazil
- 2Paulista School of Medicine – Federal University of São Paulo (UNIFESP), Department of Diagnostic Imaging, São Paulo, Brazil
- 3Hospital Sírio-Libanês, Clinic of Radiology, São Paulo, SP, Brazil
- 4University of Florida Faculty of Medicine, Department of Radiology, Division of Vascular and Interventional Radiology, Jacksonville, United States of America
- 5Uberlandia Medical Center, Clinic of Radiology, Uberlândia, Brazil
- 6Associate Professor Hospital das Clínicas, University of São Paulo Medical School (HC-FMUSP), Urologist and Medical Director, Hospital Sírio-Libanês, São Paulo, Brazil
Abstract
PURPOSE: To evaluate the feasibility, reproducibility, and clinical outcomes of an image-guided, urethra-sparing transperineal radiofrequency ablation (TPTA) strategy for benign prostatic hyperplasia (BPH) in an outpatient interventional radiology setting.
METHODS: This was a prospective, bicenter, non-randomized study of consecutive men with moderate-to-severe lower urinary tract symptoms (LUTS) refractory or intolerant to medication treated with ultrasound-guided, urethra-sparing TPTA. Outcomes included the International Prostate Symptom Score (IPSS), quality of life, maximum urinary flow rate (Qmax), post-void residual volume (PVR), prostate volume, prostate-specific antigen (PSA), and ejaculatory function [assessed using the Male Sexual Health Questionnaire–Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF)]; complications were graded using the Clavien–Dindo classification. The primary endpoint was a 12-month change in ejaculatory function; secondary endpoints included composite clinical response (≥ 30% IPSS reduction without retreatment) and urinary and structural changes.
RESULTS: At 12 months, clinically meaningful improvements were observed across patient-reported symptoms and concordant objective functional and anatomical parameters in a carefully selected outpatient cohort. The median IPSS decreased from 19.5 at baseline to 5.0 at 6 months and 4.0 at 12 months (P < 0.001), accompanied by sustained increases in the Qmax and reductions in PVR, prostate volume, and PSA (all P < 0.001). Among sexually active men, MSHQ-EjD-SF function scores remained stable during the follow-up period, and antegrade ejaculation was preserved in 90% of patients. The composite clinical response rate (≥ 30% IPSS reduction without retreatment) was 97.1% at both 6 and 12 months, with no device-related Clavien–Dindo ≥ III complications observed.
CONCLUSION: These findings suggest that image-guided, urethra-sparing TPTA is a reproducible outpatient interventional radiology procedure capable of achieving clinically meaningful symptom relief while preserving ejaculatory function, supporting further comparative and multicenter evaluation.
CLINICAL SIGNIFICANCE: Urethra-sparing TPTA has proven to be a safe, feasible, and effective treatment for LUTS and may represent a minimally invasive and effective alternative for BPH.
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BibTeX
@article{nunes2026imageguided,
title = {{Image-guided, urethra-sparing transperineal radiofrequency ablation for benign prostatic hyperplasia: a prospective bicenter outpatient study}},
author = {Thiago Franchi Nunes and Denis Szejnfeld and Públio Cesar Cavalcante Viana and Flávio Scavone Stefanini and Vinicius Adami Vayego Fornazari and Túlio Fabiano de Oliveira Leite and Alvaro Sadek Sarkis and Hugo Alexandre Socrates de Castro},
journal = {Diagnostic and Interventional Radiology},
year = {2026},
month = nov,
doi = {10.4274/dir.2026.263745},
url = {https://doi.org/10.4274/dir.2026.263745},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Image-guided, urethra-sparing transperineal radiofrequency ablation for benign prostatic hyperplasia: a prospective bicenter outpatient study
AU - Thiago Franchi Nunes
AU - Denis Szejnfeld
AU - Públio Cesar Cavalcante Viana
AU - Flávio Scavone Stefanini
AU - Vinicius Adami Vayego Fornazari
AU - Túlio Fabiano de Oliveira Leite
AU - Alvaro Sadek Sarkis
AU - Hugo Alexandre Socrates de Castro
PY - 2026
DA - 2026/11/02
JO - Diagnostic and Interventional Radiology
DO - 10.4274/dir.2026.263745
UR - https://doi.org/10.4274/dir.2026.263745
AB - PURPOSE: To evaluate the feasibility, reproducibility, and clinical outcomes of an image-guided, urethra-sparing transperineal radiofrequency ablation (TPTA) strategy for benign prostatic hyperplasia (BPH) in an outpatient interventional radiology setting. METHODS: This was a prospective, bicenter, non-randomized study of consecutive men with moderate-to-severe lower urinary tract symptoms (LUTS) refractory or intolerant to medication treated with ultrasound-guided, urethra-sparing TPTA. Outcomes included the International Prostate Symptom Score (IPSS), quality of life, maximum urinary flow rate (Qmax), post-void residual volume (PVR), prostate volume, prostate-specific antigen (PSA), and ejaculatory function [assessed using the Male Sexual Health Questionnaire–Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF)]; complications were graded using the Clavien–Dindo classification. The primary endpoint was a 12-month change in ejaculatory function; secondary endpoints included composite clinical response (≥ 30% IPSS reduction without retreatment) and urinary and structural changes. RESULTS: At 12 months, clinically meaningful improvements were observed across patient-reported symptoms and concordant objective functional and anatomical parameters in a carefully selected outpatient cohort. The median IPSS decreased from 19.5 at baseline to 5.0 at 6 months and 4.0 at 12 months (P < 0.001), accompanied by sustained increases in the Qmax and reductions in PVR, prostate volume, and PSA (all P < 0.001). Among sexually active men, MSHQ-EjD-SF function scores remained stable during the follow-up period, and antegrade ejaculation was preserved in 90% of patients. The composite clinical response rate (≥ 30% IPSS reduction without retreatment) was 97.1% at both 6 and 12 months, with no device-related Clavien–Dindo ≥ III complications observed. CONCLUSION: These findings suggest that image-guided, urethra-sparing TPTA is a reproducible outpatient interventional radiology procedure capable of achieving clinically meaningful symptom relief while preserving ejaculatory function, supporting further comparative and multicenter evaluation. CLINICAL SIGNIFICANCE: Urethra-sparing TPTA has proven to be a safe, feasible, and effective treatment for LUTS and may represent a minimally invasive and effective alternative for BPH.
SN - 1305-3825
SN - 1305-3612
ER -