Outcomes and safety of trans perineal laser ablation of the prostate: a systematic review

ObjectiveProstate trans-perineal laser ablation (TPLA) is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that is gaining importance as an alternative to the standard of care, namely transurethral resection of the prostate (TURP). To evaluate the functional outcomes and rates of complication in BPH patients with LUTS who underwent TPLA.Materials and methodsWe performed a scoping systematic review (PROSPERO id CRD42024612152) on PubMed/Medline, Embase, and the Cochrane Library in June 2025 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement. Identified reports were reviewed according to the methodological index for non-randomized studies (MINORS).ResultsOverall, 17 studies (13 prospective and four retrospective studies) involving 717 patients were analyzed. However, study heterogeneity and limited long-term data hinder a comprehensive and unbiased comparison with TURP. Prostate TPLA was associated with improvements at 12-month in LUTS (Delta of IPPS and QoL ranged from 40.7 to 72.7% and from 50 to 75%, respectively) as well as patient satisfaction, and uroflowmetry measures (Delta of Qmax and Post-voidal residuum ranged from 42.8 to 127.7% and from 28.4 to 86.4%). Moreover, ejaculatory functioning was preserved. Prostate TPLA-related complication rates were low, with most adverse effects classified as Clavien-Dindo grade II.ConclusionsRetrospective evidence widely suggests that prostate TPLA is a suitable option for BPH treatment. Future research, especially randomized controlled trials, are needed to confirm prostate TPLA efficacy over a period longer than the standard 12-month follow-up and assess its cost-effectiveness relative to TURP.