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Transperineal laser ablation in the management of benign prostatic hyperplasia: an updated systematic review and pooled analysis

Prostate Cancer and Prostatic Diseases (2025)Cite this article

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Abstract

Introduction

Standard surgical options for Benign Prostatic Hyperplasia [BPH], despite their excellent functional outcomes, are associated with multiple side effects and require general/spinal anesthesia and hospitalization. In this scenario, Transperineal Laser Ablation of the Prostate [TPLA] emerged as an ultra-minimally invasive ejaculation-sparing procedure, showing promising functional results, with a good safety profile. This systematic review aimed to provide an overview of the current role of TPLA in clinical practice, focusing on operative setting, safety, and efficacy.

Evidence acquisition

Literature search was performed on June 12th, 2024 using PubMed, Embase, and Cochrane Central databases, following the EAU Guidelines Office and the PRISMA statement recommendations. All studies reporting outcomes after TPLA procedures were included.

Evidence synthesis

Seventeen studies were included in this systematic review, of which 2 RCTs compared TPLA with TURP, 12 prospective and 3 retrospective non-randomized studies (of which 1 comparing TPLA and Prostatic Artery Embolization [PAE]). All procedures were performed using the same EchoLaserTM system (SoracteLiteTM) (Elesta s.r.l., Calenzano (FI), Italy), however great heterogeneity exists considering inclusion criteria, peri- and post-operative management. Mainly low-grade complications (Clavien-Dindo [CD] Grade ≤ II) were reported, while no major adverse events (CD grade > III) occurred. In all studies TPLA led to a great improvement in urinary function, up to 5 years after the procedure, while not significantly impacting erectile and ejaculatory functions.

Conclusions

TPLA showed promising results both in the short- and mid-term, improving urinary function while preserving sexual function and keeping a good safety profile. Since the evidence available is still limited, larger prospective comparative studies are warranted to confirm the efficacy of TPLA and to adequately compare it to standard endoscopic techniques and other minimally invasive surgical treatments.

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Fig. 1: The Cochrane Handbook for Systematic Reviews of Interventions risk-of-bias tool for RCTs.
Fig. 2: The Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool for prospective studies.
Fig. 3: Preferred reporting items for systematic review and meta-analysis (PRISMA) flowchart.
Fig. 4: Forest plot displaying the pooled effect on functional outcomes after TPLA.

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Author notes

  1. These authors contributed equally: Andrea Alberti, Mattia Lo Re.

Authors and Affiliations

  1. Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence Careggi Hospital, Florence, Italy

    Andrea Alberti, Mattia Lo Re, Rossella Nicoletti, Paolo Polverino, Anna Cadenar, Elena Ciaralli, Francesca Solazzi, Beatrice Giustozzi, Francesco Sessa, Anna Rivetti, Riccardo Campi, Arcangelo Sebastianelli, Sergio Serni & Mauro Gacci

  2. Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy

    Andrea Alberti, Mattia Lo Re, Rossella Nicoletti, Paolo Polverino, Anna Cadenar, Elena Ciaralli, Francesca Solazzi, Beatrice Giustozzi, Francesco Sessa, Anna Rivetti, Riccardo Campi, Arcangelo Sebastianelli, Sergio Serni & Mauro Gacci

  3. Department of Surgery, S.H.Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China

    Rossella Nicoletti

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Contributions

AA, MLR, RN, and PP were responsible for interpreting data, editing and revising the tables, and writing the paper. EC, FS, and BG were responsible for collecting and reviewing journal articles, editing summary tables, and editing the manuscript. AA and AC were responsible for data analysis. MG was responsible for designing the review protocol, coordinating the group, and supervising the project. FS, AR, RC, AS, and SS provided feedback on the manuscript.

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Correspondence to Mauro Gacci.

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As this is a systematic review, institutional review board or patient consent was not required. As for all systematic reviews, the patients presented in this systematic review have been previously reported.

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Alberti, A., Lo Re, M., Nicoletti, R. et al. Transperineal laser ablation in the management of benign prostatic hyperplasia: an updated systematic review and pooled analysis. Prostate Cancer Prostatic Dis (2025). https://doi.org/10.1038/s41391-025-00952-1

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