Office-based transperineal laser ablation for benign prostatic hyperplasia: Functional outcomes and predictors of clinical improvement.

INTRODUCTION

Transperineal laser ablation (TPLA) is an ultrasound-guided, office-based procedure for the treatment of benign prostatic hyperplasia (BPH). This study evaluates short-term functional outcomes following TPLA and identifies predictors of clinical improvement.

MATERIAL AND

METHODS

This cohort included men undergoing TPLA between January 1, 2025, and February 1, 2026, using a transperineal interstitial laser system (EchoLaser, Elesta SpA). Minimum follow-up was 6 months. Variables included age, body mass index (BMI), prostate-specific antigen (PSA), PSA density, testosterone, prostate volume, International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and post-void residual (PVR). Intraoperative variables included ablation time and energy delivered. Pre- and post- treatement differences were assessed using the Wilcoxon signed rank test. Spearman correlation analysis evaluated predictors of improvement.

RESULTS

Thirty-five of forty men met the inclusion criteria. Mean prostate volume was 71.6 cm3 (range 29.8-196). Mean IPSS improved from 23.5 to 10.6 (p <0.001). Qmax increased from 7.2 to 18.4 ml/s (p = 0.007). PVR decreased from 396.8 to 70.6 ml (p <0.001). Comorbidities included urinary tract infection or urosepsis history, hypertension, diabetes, hypercholesterolemia, and anticoagulation use. Postoperative complications included three patients with urinary retention requiring catheterization and one patient with urosepsis requiring hospitalization. Greater improvement correlated with higher baseline IPSS and PVR (p <0.001).

CONCLUSIONS

Office-based TPLA produced significant short term functional improvement. Functional gains were comparable to those achieved with hospital based surgical interventions. Prospective, multicenter, randomized studies are warranted to further evaluate long term durability.