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.

Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project

“…Sessa et al. [ 3 , 4 ] also used it for large prostates, while de Rienzo et al. [ 6 ] considered it useful for prostates mainly developed in the longitudinal direction and Manenti et al.…”

“…Experts agreed that patients can be discharged 2–4 h after the procedure, despite most studies reported a hospitalization of 1–2 days [ [5] , [6] , [7] , 9 ]. Instead, there are two recent clinical trials in which patients have been safely discharged the same day of the treatment, if no complications occurred during the 2–3 h observation period [ 1 , 3 , 4 ].…”

“…Transperineal laser ablation (TPLA) of the prostate using the Echolaser® system (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) is a novel minimally invasive technique which provides a thermal ablation of the prostatic tissue thanks to laser–tissue interaction that induces cell death. The resulting coagulative necrosis leads to a post-necrotic reabsorption of the treated area [ [1] , [2] , [3] , [4] ].…”

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

“…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.…”

Standard approach and future perspective for the management of benign prostatic hyperplasia from a health-economics point of view: the role of transperineal laser ablation

“…In January 2023, Sessa et al (26) have published a review with the aim to revise the current evidence on surgical and functional outcomes related to TPLA for LUTS due to BPH. The review included 7 studies of which 6 we have presented.…”