Transperineal laser ablation for high-volume benign prostatic hyperplasia: a prospective study of efficacy and safety

Antonio Ruffo¹, Fabio Esposito², Vincenzo Maria Altieri¹, Ester Illiano³, Lorenzo Spirito⁴, Valerio Santarelli⁵, Francesco Del Giudice^5,*, Felice Crocetto⁶, Biagio Barone⁷
1 Dipartimento di Medicina e di Scienze della Salute “Vincenzo Tiberio”, Università degli Studi del Molise, Campobasso, Italy
2 Casa di Cura Nostra Signora di Lourdes, Massa di Somma, Naples, Italy
3 Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
4 Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
5 Department of Maternal-Infant and Urological Sciences, Umberto I Hospital, “Sapienza” University of Rome, Rome, Italy
6 Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy
7 Department of Urology, P.O. “San Paolo”, ASL NA1 Centro, Naples, Italy
* Corresponding Author: Francesco Del Giudice. Email: email
(This article belongs to the Special Issue: Prostatic Enucleation: Current Evidence and Contemporary Practice)

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.081080

Received 23 February 2026; Accepted 25 May 2026; Published online 06 July 2026

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Abstract

Objectives: Transperineal Laser Ablation (TPLA) has emerged as a minimally invasive/ejaculation-sparing alternative to traditional benign prostatic hyperplasia (BPH) surgical treatments. Aim of this study was to evaluate the mid-term outcomes of TPLA in treating patients with high-volume BPH. Methods: This prospective study included 66 patients with large-volume BPH (median volume 95 mL, IQR 78–120). A significant proportion presented with previous acute urinary retention (48.5%), with 28.8% being catheter-dependent preoperatively. All TPLA procedures were performed under local anesthesia. Efficacy was assessed by changes in the International Prostate Symptom Score (IPSS), quality of life index (IQoL), maximum flow rate (Qmax), post-void residual (PVR) volume, and prostate volume from baseline to 3, 6, and 12 months. Statistical analysis utilized non-parametric tests. Results: TPLA demonstrated significant and rapid improvements in all parameters. Median prostate volume reduction was 42.1% at 3 months (55 mL, p < 0.0001) and 57.9% at 12 months (40 mL, p < 0.0001). Symptom burden decreased markedly, with median IPSS improving from 20 (severe) to 6 (mild) at 12 months (p < 0.0001). IQoL scores improved from 4 to 1. Obstructive parameters resolved effectively: Qmax doubled from 8 mL/s to 18 mL/s (p < 0.0001), and median PVR decreased from 80 mL to 0 mL. All patients were free from BPH therapy at 12 months. All preoperatively catheterized patients were successfully decatheterized. The complication rate was low (<10%), with all events being minor (Clavien-Dindo I-II). Conclusion: TPLA is a highly effective, minimally invasive treatment for high-volume BPH, within the limitations of a single-arm study, facilitating substantial tissue reduction and thus leading to significant symptomatic improvement.