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Introduction <p>Standard surgical options for Benign Prostatic Hyperplasia [BPH], despite their excellent functional outcomes, are associated with multiple side effects and require general/spinal anesthesia and hospitalization. In this scenario, Transperineal Laser Ablation of the Prostate [TPLA] emerged as an ultra-minimally invasive ejaculation-sparing procedure, showing promising functional results, with a good safety profile. This systematic review aimed to provide an overview of the current role of TPLA in clinical practice, focusing on operative setting, safety, and efficacy.</p> Evidence acquisition <p>Literature search was performed on June 12th, 2024 using PubMed, Embase, and Cochrane Central databases, following the EAU Guidelines Office and the PRISMA statement recommendations. All studies reporting outcomes after TPLA procedures were included.</p> Evidence synthesis <p>Seventeen studies were included in this systematic review, of which 2 RCTs compared TPLA with TURP, 12 prospective and 3 retrospective non-randomized studies (of which 1 comparing TPLA and Prostatic Artery Embolization [PAE]). All procedures were performed using the same EchoLaser<sup>TM</sup> system (SoracteLite<sup>TM</sup>) (Elesta s.r.l., Calenzano (FI), Italy), however great heterogeneity exists considering inclusion criteria, peri- and post-operative management. Mainly low-grade complications (Clavien-Dindo [CD] Grade ≤ II) were reported, while no major adverse events (CD grade &gt; III) occurred. In all studies TPLA led to a great improvement in urinary function, up to 5 years after the procedure, while not significantly impacting erectile and ejaculatory functions.</p> Conclusions <p>TPLA showed promising results both in the short- and mid-term, improving urinary function while preserving sexual function and keeping a good safety profile. Since the evidence available is still limited, larger prospective comparative studies are warranted to confirm the efficacy of TPLA and to adequately compare it to standard endoscopic techniques and other minimally invasive surgical treatments.</p>

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Transperineal laser ablation in the management of benign prostatic hyperplasia: an updated systematic review and pooled analysis

  • 期刊论文

  • 发表日期：

    2025年3月12日

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  • Andrea Alberti,
  • Mattia Lo Re,
  • Rossella Nicoletti,
  • Paolo Polverino,
  • Anna Cadenar,
  • Elena Ciaralli,
  • Francesca Solazzi,
  • Beatrice Giustozzi,
  • Francesco Sessa,
  • Anna Rivetti,
  • Riccardo Campi,
  • Arcangelo Sebastianelli,
  • Sergio Serni,
  • Mauro Gacci

摘要

Introduction

Standard surgical options for Benign Prostatic Hyperplasia [BPH], despite their excellent functional outcomes, are associated with multiple side effects and require general/spinal anesthesia and hospitalization. In this scenario, Transperineal Laser Ablation of the Prostate [TPLA] emerged as an ultra-minimally invasive ejaculation-sparing procedure, showing promising functional results, with a good safety profile. This systematic review aimed to provide an overview of the current role of TPLA in clinical practice, focusing on operative setting, safety, and efficacy.

Evidence acquisition

Literature search was performed on June 12th, 2024 using PubMed, Embase, and Cochrane Central databases, following the EAU Guidelines Office and the PRISMA statement recommendations. All studies reporting outcomes after TPLA procedures were included.

Evidence synthesis

Seventeen studies were included in this systematic review, of which 2 RCTs compared TPLA with TURP, 12 prospective and 3 retrospective non-randomized studies (of which 1 comparing TPLA and Prostatic Artery Embolization [PAE]). All procedures were performed using the same EchoLaserTM system (SoracteLiteTM) (Elesta s.r.l., Calenzano (FI), Italy), however great heterogeneity exists considering inclusion criteria, peri- and post-operative management. Mainly low-grade complications (Clavien-Dindo [CD] Grade ≤ II) were reported, while no major adverse events (CD grade > III) occurred. In all studies TPLA led to a great improvement in urinary function, up to 5 years after the procedure, while not significantly impacting erectile and ejaculatory functions.

Conclusions

TPLA showed promising results both in the short- and mid-term, improving urinary function while preserving sexual function and keeping a good safety profile. Since the evidence available is still limited, larger prospective comparative studies are warranted to confirm the efficacy of TPLA and to adequately compare it to standard endoscopic techniques and other minimally invasive surgical treatments.