Safety and functional efficacy of transperineal laser ablation in large prostates (>80 mL): a prospective single-center study.

Authors

Francesco L Conte, Marco Saladino, Luca Lambertini, Leonardo Gajo, Neliana Kucuku, Francesca Conte, Beatrice Giustozzi, Riccardo Ferretti, Simone Posanzini, Luca Mazzola, Vincenzo Salamone, Giulia Carli, Filippo Lipparini, Federica Leo, Maro Fahoum, Marco D'Ermo, Jhosep J Carmona Garcia, Fabrizio DI Maida, Gianni Vittori, Antonio A Grosso, Andrea Minervini, Andrea Mari

Published in

Minerva urology and nephrology. Volume 78. Issue 4. Pages 583-591.

Abstract

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.
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.
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.
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.

PMID:
42823868
Bibliographic data and abstract were imported from PubMed on 02 Oct 2026.

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