Evaluating the safety and effectiveness of transperineal laser ablation of the prostate for men with enlarged prostates

This study aimed to evaluate the effectiveness and safety of transperineal laser ablation (TPLA) of the prostate for patients with lower urinary tract symptoms (LUTS) due to an enlarged prostate. The data showed that TPLA was effective and safe for these patients.

Lower urinary tract symptoms (LUTS) such as urination problems are common with age. These include the need for frequent urination, getting up during the night to urinate (nocturia), urgent and uncontrollable urges to urinate, and incontinence (involuntary urine leakage). Benign prostatic hyperplasia (BPH) is an enlargement of the prostate and a common cause of LUTS in older men.

Mild symptoms of BPH can often be managed with regular monitoring. Men with more severe symptoms may be prescribed medications such as alpha-blockers such as finasteride (Proscar). These work by blocking the nerve signals to the prostate muscle, relaxing it, and increasing the urine flow. Procedures such as transurethral resection of the prostate (TURP) or holmium-laser enucleation of the prostate (HoLEP) are also options for these men. However, these procedures are associated with lower quality of life because they affect sexual functions.

A new technique called transperineal laser ablation (TPLA) offers the promise of LUTS relief with lower risks of sexual side effects. TPLA is a minimally invasive technique that uses low energy deep in the tissues to destroy prostate tissue blocking urine flow. The procedure involves inserting 2 fine fibers into the prostate through the perineum (the area between the anus and the testicles/scrotum) with ultrasound guidance. However, this new technique has limited safety and effectiveness data.

This study included 100 patients with BPH and LUTS. All patients underwent TPLA of the prostate. Urinary symptoms were evaluated through the International Prostate Symptom Score (IPSS). A higher score means more severe symptoms. Improvements in peak urinary flow rate (Qmax, the highest flow rate achieved during urination, which is reduced in patients with BPH), post-void residual volume (PVR – the quantity of urine remaining in the bladder after urination), and quality of life (QoL) were also evaluated. The average follow-up period was 12 months.

After 1 year, 72% of patients reported an improvement in the IPSS score. There were statistically significant improvements in Qmax (from 2.4ml/s to 3.9ml/s), PVR (from 90 ml to 45 ml), and QoL. All sexually active patients had normal ejaculation after the procedure. The procedure succeeded in 91% of cases.

99 patients were discharged the same day and 1 patient needed overnight hospitalization for lower abdomen pain but was discharged the next day. There were no complications during the procedure. 2% of patients experienced a urinary tract infection (UTI) treated with antibiotics in the first 3 months. No serious postoperative complications were reported.

This study concluded that TPLA was effective and safe for selected patients with LUTS due to an enlarged prostate.

This study only included patients treated at one center. This potentially limits the ability to generalize the results. Further studies on a larger extent are needed and there is also a need to compare TPLA treatment to other minimally-invasive techniques or standard surgery treatments.