Transperineal laser ablation Ideal for BPH Cases wishing to avoid ejaculatory dysfunction

Researchers led by Halil Lutfi Canat conducted a prospective, randomized, and controlled study to compare the outcomes of two common techniques for treating prostate enlargement: Transurethral Resection of the Prostate (TURP) and Transperineal Laser Ablation (TPLA) as published in International Urology And Nephrology. TURP is considered the gold standard method, while TPLA offers potential advantages, including preserving ejaculatory function and minimizing anaesthesia risks. The study aimed to assess the first-year results of both procedures and their impact on various urological and sexual health parameters.

Between November 2021 and February 2023, fifty patients eligible for TURP were enrolled in the study and randomly assigned to either the TURP or TPLA group. Demographic data, perioperative details, and preoperative and first-year measurements of several parameters were recorded, including International Prostate Symptom Score (IPSS), International Erectile

Function Index (IIEF-5), Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD), quality of life (QoL), peak urinary flow rate (Qmax), prostate volume (PV), and postvoid residual (PVR).

● Both TURP and TPLA groups showed improvement in IPSS, Qmax, and PVR parameters compared to baseline values after one year (p < 0.01).

● TURP demonstrated better improvement in Qmax compared to TPLA (p < 0.01).

● The IIEF-5 score, which assesses erectile function, was similar between both groups (p = 0.83 and p = 0.12, respectively), indicating that TPLA did not compromise erectile function. In the TPLA group, the MSHQ scores, evaluating ejaculatory function, remained unchanged compared to baseline values after one year (p = 0.54 and p = 0.34, respectively).

● This finding suggests that TPLA may offer a comparable symptomatic improvement without sacrificing ejaculatory function, making it a potential alternative for patients concerned about ejaculatory dysfunction or with a high risk of anaesthesia.

● TPLA may also be suitable for patients unable to discontinue anticoagulant/antiplatelet therapy.

The first-year results of Transperineal Laser Ablation (TPLA) in treating prostate enlargement showed promising outcomes, comparable to the gold standard method Transurethral Resection of the Prostate (TURP). TPLA demonstrated effective symptomatic improvement without compromising ejaculatory functions. This makes TPLA a potentially viable alternative, particularly for patients seeking to preserve sexual function, those at high anaesthesia risk, or individuals unable to discontinue anticoagulant/antiplatelet therapy. Further long-term studies and larger patient cohorts are warranted to confirm the efficacy and safety of TPLA as a treatment option for prostate enlargement.

Reference:

Canat, H. L., Gurbuz, C., & Bozkurt, M. (2023). Transurethral resection of the prostate (TURP) versus transperineal laser ablation (TPLA) due to benign prostatic hyperplasia (BPH): prospective and comparative study. International Urology and Nephrology. https://doi.org/10.1007/s11255-023-03717-8