Minerva urology and nephrology · 2026
Safety and functional efficacy of transperineal laser ablation in large prostates (>80 mL): a prospective single-center study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Conte Francesco L, Saladino Marco, Lambertini Luca, Gajo Leonardo, Kucuku Neliana, Conte Francesca, Giustozzi Beatrice, Ferretti Riccardo, Posanzini Simone, Mazzola Luca, Salamone Vincenzo, Carli Giulia, Lipparini Filippo, Leo Federica, Fahoum Maro, D'Ermo Marco, Carmona Garcia Jhosep J, DI Maida Fabrizio, Vittori Gianni, Grosso Antonio A, Minervini Andrea, Mari Andrea
Аннотация
BACKGROUND: To evaluate the safety and functional outcomes of transperineal laser ablation (TPLA) in men with large prostates (>80 mL), with specific focus on perioperative events, catheter-related outcomes, and mid-term efficacy.
METHODS: Prospective single-center observational study at a tertiary referral institution. Consecutive patients undergoing TPLA between September 2022 and December 2024 were analyzed; 85 met inclusion criteria (>80 mL). Procedures were outpatient under local anesthesia (± oral benzodiazepines) with transrectal ultrasound guidance. Three-four fibers were used per case (four in 91.8%); median total energy 10,000 J (IQR 9000-12,000), energy density 105 J/mL (IQR 95-125). Follow-up until 36 months with all the patients receiving a follow-up of at least 12 months. Outcomes included IPSS, QoL, MSHQ-EjD, Qmax, PVR; complications were graded by Clavien-Dindo.
RESULTS: Median age was 67 years; baseline uroflowmetry indicated marked obstruction (Median Qmax 9 mL/s; PVR 120 mL; IPSS 16). Catheter removal failure occurred in 24.7% at day 7 and 7.1% at day 14; 3.5% remained catheter-dependent at 30 days. Overall complications were 22.4%, predominantly grade ≤ II; one intraprostatic abscess (1.2%). No transfusions, sepsis, urethral stricture, de novo erectile or ejaculatory dysfunction were observed; transient mild incontinence occurred in 1.2%. Qmax improved modestly at 3 months (+1 mL/s; P=0.04) and markedly at 6 months (+5 mL/s; P<0.0001), remaining stable thereafter. IPSS decreased significantly through 12-24 months (-10 points; P<0.0001); PVR reduction became significant from 6 months; ejaculatory scores improved; secondary HoLEP was required in 12.9%. Median follow-up was 18 months.
CONCLUSIONS: In prostates >80 mL, TPLA under local anesthesia is feasible and safe, yielding delayed yet substantial improvements in LUTS and flowmetry from 6 months onward, low sphincter-related morbidity, and preserved ejaculation. TPLA may complement enucleation procedures as a volume-adapted, minimally invasive option for selected patients.
METHODS: Prospective single-center observational study at a tertiary referral institution. Consecutive patients undergoing TPLA between September 2022 and December 2024 were analyzed; 85 met inclusion criteria (>80 mL). Procedures were outpatient under local anesthesia (± oral benzodiazepines) with transrectal ultrasound guidance. Three-four fibers were used per case (four in 91.8%); median total energy 10,000 J (IQR 9000-12,000), energy density 105 J/mL (IQR 95-125). Follow-up until 36 months with all the patients receiving a follow-up of at least 12 months. Outcomes included IPSS, QoL, MSHQ-EjD, Qmax, PVR; complications were graded by Clavien-Dindo.
RESULTS: Median age was 67 years; baseline uroflowmetry indicated marked obstruction (Median Qmax 9 mL/s; PVR 120 mL; IPSS 16). Catheter removal failure occurred in 24.7% at day 7 and 7.1% at day 14; 3.5% remained catheter-dependent at 30 days. Overall complications were 22.4%, predominantly grade ≤ II; one intraprostatic abscess (1.2%). No transfusions, sepsis, urethral stricture, de novo erectile or ejaculatory dysfunction were observed; transient mild incontinence occurred in 1.2%. Qmax improved modestly at 3 months (+1 mL/s; P=0.04) and markedly at 6 months (+5 mL/s; P<0.0001), remaining stable thereafter. IPSS decreased significantly through 12-24 months (-10 points; P<0.0001); PVR reduction became significant from 6 months; ejaculatory scores improved; secondary HoLEP was required in 12.9%. Median follow-up was 18 months.
CONCLUSIONS: In prostates >80 mL, TPLA under local anesthesia is feasible and safe, yielding delayed yet substantial improvements in LUTS and flowmetry from 6 months onward, low sphincter-related morbidity, and preserved ejaculation. TPLA may complement enucleation procedures as a volume-adapted, minimally invasive option for selected patients.