Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Clinical Research
  • Published:

Trans - Perineal laser ablation of the prostate in high surgical risk patients affected by severe lower urinary tract symptoms related to benign prostatic obstruction

Prostate Cancer and Prostatic Diseases (2023)Cite this article

Subjects

Abstract

Background

In our study, we aimed to test the efficacy and safety of Trans-Perineal Laser Ablation of the prostate (TPLA®) in the surgical treatment of high-risk Benign Prostatic Obstruction (BPO) patients.

Methods

We defined a high-risk BPO patient as an elderly man affected by severe comorbidities, among which coagulation issues due to pre-existent medications or diseases. From October 2020 to June 2022, we prospectively enrolled high-risk patients affected by a moderate to severe and/or complicated BPO condition. The analysis of the efficacy of the Trans-Perineal Laser Ablation was defined as the primary endpoint of the study. Secondary endpoints were post-operative surgical complications and patient-reported quality of life.

Results

Globally, 40 consecutive patients were enrolled. Median (IQR) age was 80 (72.5–84) years. Median Charlson Comorbidity Index was 6 (5–7). Median prostate volume was 38 (30.5–73) cc. In all cases, a TPLA® procedure was performed under local anesthesia, and patients being discharged within the same day of the procedure. A progressive reduction of median prostate volumes was reported at 3 and 6 months post-operatively, compared to baseline [38 (30.5–73) vs 35 (26–49) vs 34 (28–49) cc, p < 0.001]. Median International Prostate Symptom Score (IPSS) improved accordingly [25 (19–30) vs 10.5 (7.5–13) vs 8 (6–11.5), p < 0.001]. A permanent bladder catheter was successfully removed in 13 out of 23 (56.5%) cases. Within 90 days from surgery, 19 (47.5%) patients experienced at least one surgical complication. According to the Clavien-Dindo classification, complications were classified as grade I in 16 (40%) cases, grade II in 9 (22.5%), and grade III in 1 (2.5%). We did not observe any grade IV or V complications.

Conclusions

The Trans-Perineal Laser Ablation of the Prostate is a feasible, safe, and effective Minimally Invasive Surgical Technique, when offered to elderly, high-risk patients affected by severe Benign Prostatic Obstruction.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Boxplot report of functional outcomes after trans-perineal laser ablation of the prostate.

Similar content being viewed by others

Data availability

The datasets generated during and/or analysed during the current study are not publicly available due to patients’ privacy protection policy, but are available from the corresponding author on reasonable request.

References

  1. Manfredi C, Arcaniolo D, Spatafora P, Crocerossa F, Fusco F, Verze P, et al. Emerging minimally invasive transurethral treatments for benign prostatic hyperplasia: a systematic review with meta-analysis of functional outcomes and description of complications. Minerva Urol Nephrol. 2022;74:389–99.

    Article  PubMed  Google Scholar 

  2. Roehrborn CG, Issa MM, Bruskewitz RC, Naslund MJ, Oesterling JE, Perez-marrero R, et al. Transurethral needle ablation for prostatic hyperplasia: 12-Month results of a prospective, multicenter US study. Urology. 1998;51:415–21.

    Article  CAS  PubMed  Google Scholar 

  3. McNicholas TA, Steger AC, Bown SG. Interstitial laser coagulation of the prostate. An experimental study. Br J Urol. 1993;71:439–44.

    Article  CAS  PubMed  Google Scholar 

  4. Nguyen D-D, Li T, Ferreira R, Baker Berjaoui M, Nguyen A-LV, Chughtai B, et al. Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: a review of Aquablation, Rezum, and transperineal laser prostate ablation. Prostate Cancer Prostatic Dis (2023). https://www.nature.com/articles/s41391-023-00669-z.

  5. Bertolo R, Iacovelli V, Cipriani C, Carilli M, Vittori M, Antonucci M, et al. Ejaculatory function following transperineal laser ablation vs TURP for benign prostatic obstruction: a randomized trial. BJU Int. 2023;132:100–8.

    Article  PubMed  Google Scholar 

  6. Cindolo L, Campobasso D, Conti E, Uricchio F, Franzoso F, Maruzzi D, et al. Do patients treated with water vapor therapy and meeting randomized clinical trial criteria have better urinary and sexual outcomes than an unselected cohort. J Endourol. 2023;37:323–9.

    Article  PubMed  Google Scholar 

  7. Ahn S-T, Lee D-H, Cho S-B, Lee H-S, Han D-E, Park T-Y, et al. Is prostate urethral lift effective in patients with multiple comorbidities? J Clin Med. 2022;11:1928.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Tadrist A, Baboudjian M, Bah MB, Alegorides C, Bottet F, Arroua F, et al. Water vapor thermal therapy for indwelling urinary catheter removal in frail patients. Int Urol Nephrol. 2023;55:249–53.

    Article  PubMed  Google Scholar 

  9. Cornu JN, Gacci M, Hashim H, Herrmann TRW, Malde S, Netsch C, et al. EAU: Guidelines on Male Lower Urinary Tract Symptoms (LUTS), including Benign Prostatic Obstruction (BPO). Eur Assoc Urol (2023).

  10. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lebdai S, Chevrot A, Doizi S, Pradere B, Delongchamps NB, Benchikh A, et al. Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment. World J Urol. 2019;37:299–308.

    Article  PubMed  Google Scholar 

  12. Sokolakis I, Pyrgidis N, Russo GI, Sountoulides P, Hatzichristodoulou G. Preserving ejaculation: a guide through the landscape of interventional and surgical options for benign prostatic obstruction. Eur Urol Focus. 2022;8:380–3.

    Article  PubMed  Google Scholar 

  13. Huang J, Chan C-K, Yee S, Deng Y, Bai Y, Chan SC, et al. Global burden and temporal trends of lower urinary tract symptoms: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2023;26:421–8.

    Article  PubMed  Google Scholar 

  14. Marra G, Sturch P, Oderda M, Tabatabaei S, Muir G, Gontero P. Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men’s ejaculatory function: time for a bespoke approach? Int J Urol. 2016;23:22–35.

    Article  PubMed  Google Scholar 

  15. Sibona M, Destefanis P, Vercelli E, Secco S, Gontero P, Cindolo L. Ejaculation physiology and dysfunction after BPH surgery: the role of the new MISTs. Prostate Cancer Prostatic Dis. 2023;26:475–82.

    Article  PubMed  Google Scholar 

  16. Cacciamani GE, Cuhna F, Tafuri A, Shakir A, Cocci A, Gill K, et al. Anterograde ejaculation preservation after endoscopic treatments in patients with bladder outlet obstruction: Systematic review and pooled-analysis of randomized clinical trials. Minerva Urol Nefrol. 2019;71:427–34.

    Article  PubMed  Google Scholar 

  17. Campobasso D, Siena G, Chiodini P, Conti E, Franzoso F, Maruzzi D, et al. Composite urinary and sexual outcomes after Rezum: an analysis of predictive factors from an Italian multi-centric study. Prostate Cancer Prostatic Dis. 2023;26:410–4.

    Article  PubMed  Google Scholar 

  18. Woo HH, Huang CP, Huang WJ, Chang YH, Lien CS, Chkhotua A, et al. The EXPANDER-1 trial: introduction of the novel UrocrossTM Expander System for treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Prostate Cancer Prostatic Dis. 2022;25:576–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kaplan SA, Pichardo M, Rijo E, Espino G, Lay RR, Estrella R. One-year outcomes after treatment with a drug-coated balloon catheter system for lower urinary tract symptoms related to benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 2021;24:1073–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sahakyan Y, Erman A, Bhojani N, Chughtai B, Zorn KC, Sander B, et al. Pharmacotherapy vs. minimally invasive therapies as initial therapy for moderate-to-severe benign prostatic hyperplasia: a cost-effectiveness study. Prostate Cancer Prostatic Dis. 2023;26:113–8.

    Article  PubMed  Google Scholar 

  21. Roehrborn CG, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, et al. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. study. J Urol. 2013;190:2161–7.

    Article  PubMed  Google Scholar 

  22. Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M. Transurethral resection of the prostate (TURP) versus original and PErFecTED prostate artery embolization (PAE) due to benign prostatic hyperplasia (BPH): preliminary results of a single center, prospective, urodynamic-controlled analysis. Cardiovasc Interv Radio. 2016;39:44–52.

    Article  Google Scholar 

  23. Huang MM, Winoker JS, Matlaga BR, Allaf ME, Koo K. Evidence-based analysis of online consumer information about prostate artery embolization for benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 2021;24:106–13.

    Article  PubMed  Google Scholar 

  24. Patelli G, Ranieri A, Paganelli A, Mauri G, Pacella CM. Transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: a feasibility study. Cardiovasc Interv Radio. 2017;40:1440–6.

    Article  Google Scholar 

  25. de Rienzo G, Lorusso A, Minafra P, Zingarelli M, Papapicco G, Lucarelli G, et al. Transperineal interstitial laser ablation of the prostate, a novel option for minimally invasive treatment of benign prostatic obstruction. Eur Urol. 2021;80:95–103.

    Article  PubMed  Google Scholar 

  26. Pacella CM, Patelli G, Iapicca G, Manenti G, Perretta T, Ryan CP, et al. Transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: a feasibility study. Results at 6 and 12 months from a retrospective multi-centric study. Prostate Cancer Prostatic Dis. 2020;23:356–63.

    Article  CAS  PubMed  Google Scholar 

  27. Laganà A, Di Lascio G, Di Blasi A, Licari LC, Tufano A, Flammia RS, et al. Ultrasound-guided SoracteLiteTM transperineal laser ablation (TPLA) of the prostate for the treatment of symptomatic benign prostatic hyperplasia (BPH): a prospective single-center experience. World J Urol. 2023;41:1157–62.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tafuri A, Panunzio A, De Carlo F, Luperto E, Di Cosmo F, Cavaliere A, et al. Transperineal laser ablation for benign prostatic enlargement: a systematic review and pooled analysis of pilot studies. J Clin Med. 2023;12:1860.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sessa F, Polverino P, Siena G, Bisegna C, Lo Re M, Spatafora P, et al. Transperineal laser ablation of the prostate (TPLA) for lower urinary tract symptoms due to benign prostatic obstruction. J Clin Med. 2023;12:793.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Canat HL, Gurbuz C, Bozkurt M. Transurethral resection of the prostate (TURP) versus transperineal laser ablation (TPLA) due to benign prostatic hyperplasia (BPH): prospective and comparative study. Int Urol Nephrol (2023). https://link.springer.com/article/10.1007/s11255-023-03717-8.

  31. Minafra P, De Rienzo G, Gerbasi S, Cindolo L, Battaglia M & Ditonno P. Three years outcomes of transperineal laser ablation of the prostate. Minerva Urol Nephrol (2023). https://www.minervamedica.it/it/riviste/minerva-urologynephrology/articolo.php?cod=R19Y9999N 00A23061401.

  32. McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, et al. Minimally invasive prostate convective water vapor energy ablation: a multicenter, randomized, controlled study for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2016;195:1529–38.

    Article  PubMed  Google Scholar 

  33. Chung DE, Wysock JS, Lee RK, Melamed SR, Kaplan SA, Te AE. Outcomes and complications after 532 nm laser prostatectomy in anticoagulated patients with benign prostatic hyperplasia. J Urol. 2011;186:977–81.

    Article  PubMed  Google Scholar 

  34. Lee DJ, Rieken M, Halpern J, Zhao F, Pueschel H, Chughtai B, et al. Laser vaporization of the prostate with the 180-W XPS-greenlight laser in patients with ongoing platelet aggregation inhibition and oral anticoagulation. Urology. 2016;91:167–73.

    Article  PubMed  Google Scholar 

  35. Knapp GL, Chalasani V, Woo HH. Perioperative adverse events in patients on continued anticoagulation undergoing photoselective vaporisation of the prostate with the 180-W Greenlight lithium triborate laser. BJU Int. 2017;119:33–38.

    Article  CAS  PubMed  Google Scholar 

  36. Fusco F, Palmieri A, Ficarra V, Giannarini G, Novara G, Longo N, et al. α1-Blockers improve benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review and meta-analysis of urodynamic studies. Eur Urol. 2016;69:1091–101.

    Article  CAS  PubMed  Google Scholar 

  37. Desai M, Bidair M, Zorn KC, Trainer A, Arther A, Kramolowsky E, et al. Aquablation for benign prostatic hyperplasia in large prostates (80–150 mL): 6-month results from the WATER II trial. BJU Int. 2019;124:321–8.

    Article  PubMed  Google Scholar 

  38. Campobasso D, Morselli S, Greco F, De Nunzio C, Destefanis P, Fasolis G, et al. Efficacy and safety profile of greenlight laser photoselective vaporization of the prostate in ≥ 75 years old patients: results from the Italian greenlight laser study group. Aging Clin Exp Res. 2023;35:877–85.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. These authors contributed equally: Paolo Destefanis, Mattia Sibona.

Authors and Affiliations

  1. Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy

    Paolo Destefanis, Mattia Sibona, Federico Vitiello, Eugenia Vercelli, Luca Micai, Gabriele Montefusco, Carlotta Mangione, Francesco Bracco, Fulvia Colucci & Paolo Gontero

  2. Urology Unit, Ospedale Sant’Andrea, La Sapienza University of Rome, Rome, Italy

    Cosimo De Nunzio

Authors
  1. Paolo Destefanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mattia Sibona
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federico Vitiello
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eugenia Vercelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luca Micai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gabriele Montefusco
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carlotta Mangione
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Francesco Bracco
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fulvia Colucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Cosimo De Nunzio
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Paolo Gontero
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PD: collected data and wrote the manuscript; MS: collected data and helped writing the study protocol and manuscript; FV, EV: helped writing the study protocol and collecting data. LM: participated in the data collection and created the figures; GM, CM, FB, FC: helped collecting data. CDN, PG: contributed to the writing and revision of the manuscript.

Corresponding author

Correspondence to Mattia Sibona.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

This original study was conducted accordingly to the Declaration of Helsinki about clinical studies on human subjects. Full IRB approval was obtained (n. 00161/2020).

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Destefanis, P., Sibona, M., Vitiello, F. et al. Trans - Perineal laser ablation of the prostate in high surgical risk patients affected by severe lower urinary tract symptoms related to benign prostatic obstruction. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00736-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41391-023-00736-5

This article is cited by

Search

Advanced search

Quick links