Efficacy and safety of ultrasonography guided transperineal percutaneous laser ablation for treating benign prostatic hyperplasia: a randomized controlled trial

Abstract

BACKGROUND: Transperineal percutaneous laser ablation (TPLA) has been proved a feasible and minimally invasive treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). However, the comparison with other therapeutic options, in particular transurethral resection of the prostate (TURP), the most widely used and gold standard surgical method for BPH patients, remained absent. METHODS: Totally 51 BPH patients treated between 6/2019 and 12/2021 who had maximum urinary flow rate (Qmax) ≤15 mL/s and international prostate symptom score (IPSS) ≥8 were enrolled and randomly assigned to TURP or TPLA group at the ratio 1:1. TPLA was conducted with Esaote MyLab Twice equipped with flexible optical fiber, and TURP was performed by Olympus UES-40 SurgMaster System under standard procedure. The results were compared at 1, 3, 6 and 12 months after the operation. The efficacy endpoints included IPSS, Qmax, quality of life (QoL), European questionnaire-five dimensions (EQ-5D), residual urine volume (RUV), international index of erectile function-5 (IIEF-5) and ejaculatory dysfunction score. The safety endpoints included the incidence of complications, blood loss, visual analogue score (VAS) of pain, and catheter indwelling time. RESULTS: The IPSS decreased by 14.17±6.13 at 3 months after TPLA, and by 13.19±5.86 after TURP (P=0.706). The complication rate of TPLA and TURP was 16% and 19.23% respectively (P=0.811).TPLA proved less Intraoperative blood loss (6.84±3.1mL,P＜0.001) and better ejaculatory protection within 6 months (P＜0.05). TURP has advantages in catheter indwelling time(P=0.012) and Qmax within 6 months(P＜0.05). CONCLUSIONS: TPLA is comparable to TURP in the symptom relief of BPH patients, and with shorter operation time, less invasiveness and better protection, which may be more suitable for patients intolerant to TURP, or with underlying diseases such as anemia.