Transperineal Laser Ablation for Benign Prostatic Enlargement: A Systematic Review and Pooled Analysis of Pilot Studies

Abstract

Transperineal laser ablation (TPLA) of the prostate is a new minimally invasive treatment option in men with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE). The aim of this systematic review was to investigate the efficacy and safety of TPLA in the management of BPE. The primary outcomes were the improvement in urodynamic parameters (maximum urinary flow (Qmax) and postvoiding residue (PVR)) and LUTS relief, assessed using the IPSS questionnaire. The secondary outcomes were the preservation of sexual and ejaculatory functions, assessed with the IEEF-5 and MSHQ-EjD questionnaires, respectively, and rates of postoperative complications. We reviewed the literature for prospective or retrospective studies evaluating the use of TPLA in the treatment of BPE. A comprehensive search in PubMed, Scopus, Web of Science, and ClinicalTrials.gov was performed for English language articles published between January 2000 and June 2022. Pooled analysis of the included studies with available follow-up data for the outcomes of interest was additionally performed. After screening 49 records, six full-text manuscripts were identified, including two retrospective and four prospective non-comparative studies. Overall, 297 patients were included. All the studies independently reported a statistically significant improvement, from baseline, in Qmax, PVR, and IPSS score at each timepoint. Three studies additionally demonstrated that TPLA did not affect sexual function, reporting no change in the IEEF-5 score, and a statistically significant improvement in MSHQ-EjD score at each timepoint. Low rates of complications were recorded in all the included studies. Pooled analysis showed a clinically meaningful improvement in both micturition and sexual outcomes mean values at 1, 3, 6, and 12 months of follow-up, compared with baseline. Transperineal laser ablation of the prostate for the treatment of BPE showed interesting results in pilot studies. However, higher level and comparative studies are needed to confirm its efficacy in relieving obstructive symptoms and preserving sexual function.

Transperineal laser ablation as a new minimally invasive surgical therapy for benign prostatic hyperplasia: a systematic review of existing literature

“…Similarly, PVR decreased from 91.94 ml at baseline, to 36 ml at 3 months, 27.57 ml at 6 months, and 22.27 ml at 12 months. 24 IPSS decreased from a mean of 20.96 at baseline to 9.8 at 3 months, 6.92 at 6 months, and 6.4 at 12 months, with a similar decrease at the QoL component. 24 Although these pooled outcomes are more easily comprehended, the strength of evidence is low since they are derived from single-arm observational studies.…”

“…24 IPSS decreased from a mean of 20.96 at baseline to 9.8 at 3 months, 6.92 at 6 months, and 6.4 at 12 months, with a similar decrease at the QoL component. 24 Although these pooled outcomes are more easily comprehended, the strength of evidence is low since they are derived from single-arm observational studies. Nevertheless, more recent data confirmed TPLA effectiveness among all of these objective and subjective outcomes.…”

“…Importantly, as highlighted by de Rienzo et al , 16 there seems to be a progressive improvement becoming more evident after 3–6 months. Tafuri et al 24 reported a pooled Qmax at baseline of 8.69 ml/s, which improved among all timepoints (3 months, 13.17 ml/s; 6 months, 14.55 ml/s; and 12 months, 17.12 ml/s). Similarly, PVR decreased from 91.94 ml at baseline, to 36 ml at 3 months, 27.57 ml at 6 months, and 22.27 ml at 12 months.…”

“…21,22 One of the most recent additions is the TPLA, with accumulating evidence showing that this is an effective and safe technique. 23,24 Two recent systematic reviews of the literature demonstrated the improvement in functional outcomes with simultaneous low complication rates and preservation of sexual function in the majority of patients; 23,24 yet, the literature search was confined to a period ending in August 2022, since when a number of new clinical studies have been released. In our updated systematic, we included new evidence, including the first reported RCT on TPLA comparing it with TURP.…”

Letter Re: ‘Ejaculatory function following transperineal laser ablation vs TURP for benign prostatic obstruction: a randomized trial’

“…It would be helpful to report changes in both at each time point. Also not mentioned are protocols for antibiotic prophylaxis and postoperative medications; as well as catheter removal criteria and timing, which might influence postoperative pain scores [2].…”