Transperineal Laser Ablation of the Prostate for Symptomatic Benign Prostatic Hyperplasia: Long-Term Follow-Up in 40 Patients

Purpose: To evaluate the durability, effectiveness, and safety of transperineal laser ablation (TPLA) of the prostate. Materials and Methods: Patients with symptomatic benign prostatic hyperplasia (BPH) underwent TPLA with a 1,064-nm continuous-wave diode laser. International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual (PVR), and prostate volume were evaluated at baseline and successive timepoints. Results: Forty prospectively enrolled patients had follow-up of ≥36 months; median duration of follow-up was 57 months (range, 36–76 months). Compared with baseline, the median reduction in IPSS at 12-month follow-up was 74% (interquartile range [IQR], 60%–81%) (P <.001). Median QoL score at 12 months was improved from 5 (IQR, 4–5) at baseline to 1 (IQR, 0–1) (P <.001). Median PVR at 12 months decreased from 108 mL (IQR, 38–178 mL) to 13.5 mL (IQR, 0–40.5 mL) (P <.001), a median reduction of 88% (IQR, 61%–100%). At 12 months, median prostate volume was significantly reduced from 66 mL (IQR, 48.5–86.5 mL) to 46 mL (IQR, 36–65 mL) (P <.001), a median reduction of 32% (IQR, 21%–45%). For all of these parameters, the benefit of TPLA persisted at last follow-up, and all changes were statistically significant compared with baseline. There were no intraprocedural adverse events; periprocedural adverse events consisted of 1 case of prostatitis and 1 case of urinary tract infection (both Society of Interventional Radiology [SIR] Grade I). Conclusions: TPLA for symptomatic BPH produced durable benefits across a range of clinical outcomes and was well tolerated in follow-up at median duration of 57 months.