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

Alessandro Tafuri; Andrea Panunzio; Francesco De Carlo; Elia Luperto; Federica Di Cosmo; Arturo Cavaliere; Mino Rizzo; Zhe Tian; Aliasger Shakir; Rita De Mitri; Antonio Benito Porcaro; Maria Angela Cerruto; Alessandro Antonelli; Luigi Cormio; Giuseppe Carrieri; Pierre I Karakiewicz; Andre Luis Abreu; Vincenzo Pagliarulo

doi:10.3390/jcm12051860

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

J Clin Med. 2023 Feb 26;12(5):1860. doi: 10.3390/jcm12051860.

Authors

Alessandro Tafuri¹, Andrea Panunzio^{2

3}, Francesco De Carlo¹, Elia Luperto¹, Federica Di Cosmo¹, Arturo Cavaliere¹, Mino Rizzo¹, Zhe Tian³, Aliasger Shakir⁴, Rita De Mitri¹, Antonio Benito Porcaro², Maria Angela Cerruto², Alessandro Antonelli², Luigi Cormio⁵, Giuseppe Carrieri⁵, Pierre I Karakiewicz³, Andre Luis Abreu⁴, Vincenzo Pagliarulo¹

Affiliations

¹ Department of Urology, "Vito Fazzi" Hospital, 73100 Lecce, Italy.
² Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, 37126 Verona, Italy.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada.
⁴ Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
⁵ Department of Urology and Renal Transplantation, University of Foggia, 71122 Foggia, Italy.

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 (Q_max) 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 Q_max, 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.

Keywords: laser ablation; minimally invasive surgical procedures; outcomes assessment; prostatic diseases.

Publication types

Review

Grants and funding

This research received no external funding.