Transperineal Laser Ablation of the Prostate (TPLA) for Lower Urinary Tract Symptoms Due to Benign Prostatic Obstruction

Abstract

We aimed to review the current evidence on surgical and functional outcomes of Transperineal Laser Ablation for LUTS due to BPH. A comprehensive review of the English-language literature was performed using the MEDLINE and Web of Science databases until 1 August 2022, aiming to select studies evaluating TPLA for the treatment of LUTS due to BPH. Additional records were found from Google Scholar. Data were extracted and summarized in Tables. An appropriate form was used for qualitative data synthesis. Seven studies were included in the review, with all being single arm, non-comparative studies. In all studies, functional outcomes were evaluated with uroflowmetry parameters and validated questionnaires, showing a promising effectiveness at short- and mid-term follow-up. There is a lack of standardized pathways for preoperative assessment of patients suitable for TPLA, and even the technique itself has been reported with a few nuances. A good safety profile has been reported by all the authors. Although promising results have been reported by different groups, selection criteria for TPLA and few technical nuances regarding the procedure were found to be heterogeneous across the published series that should be standardized in the future. Further research is needed to confirm these findings.

Keywords: benign prostatic hyperplasia (BPH); ejaculation sparing; lower urinary tract symptoms (LUTS); transperineal laser ablation of prostate (TPLA); ultra-minimally invasive surgical techniques (uMISTs).

Figure 1

The five Ws of TPLA. IV BDZ: intravenous benzodiazepine; IPSS: International Prostate Symptom Score; Qmax: maximum flow rate; MSHQ EjD: Male Sexual Health Questionnaire Ejaculation Disfunction [12,13,14,15,16,17,18].