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Short term results after minimally invasive treatments for benign prostatic enlargement: the first randomized trial comparing transperineal laser ablation and water vapor ablation

Prostate Cancer and Prostatic Diseases (2025)Cite this article

Subjects

Abstract

Background

Interest in minimally invasive techniques (MISTs) for treating benign prostatic hyperplasia (BPH) has increased over the years due to their ability to improve symptoms while minimizing complications. Moreover, these procedures can be performed in an outpatient setting, potentially reducing patients’ discomfort. The aim of our randomized trial is to evaluate and compare the efficacy of Transperineal Laser Ablation (TPLATM) and Water Vapor Ablation (WVA) in the treatment of BPH.

Methods

Eighty consecutive patients were randomized 1:1 to the two techniques between January and July 2024. Both procedures were under conscious sedations and patients were same day discharged. All patients underwent standardized follow-up, including International Prostate Symptoms Score (IPSS) and uroflowmetry assessments at 3- and 6-months post-treatment.

Results

At 6 months, IPSS and Quality of Life (QoL) scores improved significantly from baseline (p < 0.001), in favor of TPLA at both time points (p ≤ 0.03). General Linear Model analysis showed that QoL improvement was faster in the TPLA group (p: 0.005), though no significant difference persisted at 6 months. Uroflow parameters, including maximum flow, average flow, and post-void residual volume, demonstrated significant improvement without notable differences between the two groups (p < 0.001 for all comparisons). All patients were same day discharged, except one who required prolonged continuous bladder irrigation. Postoperative complications occurred in 11 cases, with only one (a prostatic abscess) classified as Clavien-Dindo ≥3. The main limitations of the study are the sample size and short follow-up duration.

Conclusions

TPLA and WVA are safe outpatient procedures that provide comparable functional outcomes. However, TPLA appears to offer a faster improvement in patient-reported symptoms.

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Fig. 1
Fig. 2: Clinical outcomes at baseline evaluation and after 3 and 6 months of follow up.
Fig. 3: Changes of IPSS and QoL scores at 3 and 6 months of follow up.
Fig. 4: Changes in PVR and Qmax at 3 and 6 months of follow up.

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Data availability

The study data are not publicly available but can be obtained from the corresponding author upon reasonable request.

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Author notes

  1. These authors contributed equally: Matteo Pacini, Alessandro Zucchi.

Authors and Affiliations

  1. Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126, Pisa, Italy

    Matteo Pacini, Alessandro Zucchi, Eleonora Sollazzi, Giada Macrì, Rachele Volterrani & Riccardo Bartoletti

  2. Department of Urology and General Medicine, Medical University of Plovdiv, 4002, Plovdiv, Bulgaria

    Matteo Pacini, Petar Antonov & Atanas Ivanov

  3. Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy

    Andrea Salonia & Alessia d’Arma

  4. Vita-Salute San Raffaele University, Milan, Italy

    Andrea Salonia

  5. Department of Medicine and Surgery, University of Perugia, 06123, Perugia, Italy

    Vittorio Bini

  6. Department of Urology, Faculty of Medicine and Psychiatry, Sant’Andrea Hospital, 00189, Rome, Italy

    Cosimo De Nunzio

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Contributions

Study design: MP, AZ, RB; data collection: ES, GM, MP, RV; data analysis: VB, MP, AZ; drafting of the first version of the manuscript: MP, RB, AZ; Critical review of the manuscript: AS, CDN, AD, PA, AI; Supervision: RB, CDN, AZ, MP.

Corresponding author

Correspondence to Matteo Pacini.

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CDN is the Editor in Chief of Prostate Cancer and Prostatic Diseases.

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Pacini, M., Zucchi, A., Salonia, A. et al. Short term results after minimally invasive treatments for benign prostatic enlargement: the first randomized trial comparing transperineal laser ablation and water vapor ablation. Prostate Cancer Prostatic Dis (2025). https://doi.org/10.1038/s41391-025-00972-x

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