Altieri Vincenzo Maria, Di Bello Francesco, Saldutto Pietro, Rocca Roberto La, Romani Marco Lucio, Vena Walter, di Mauro Ernesto, Verratti Vittore, Sangiorgi Giuseppe, Iacono Fabrizio, Pezone Gabriele, Creta Massimiliano, Napolitano Luigi, Patelli Gianluigi
Chair of Urology, Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via Sergio Pansini 5, 80131, Campobasso, Italy.
Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131, Naples, Italy.
World J Urol. 2025 Jun 23;43(1):385. doi: 10.1007/s00345-025-05753-8.
Prostate 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.
We 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).
Overall, 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 (Δ 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 (Δ 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.
Retrospective 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.
前列腺经会阴激光消融术（TPLA）是一种治疗良性前列腺增生（BPH）的微创治疗方法，作为护理标准即经尿道前列腺切除术（TURP）的替代方法，其重要性日益凸显。旨在评估接受TPLA治疗的有下尿路症状（LUTS）的BPH患者的功能结局和并发症发生率。
我们于2025年6月根据系统评价和Meta分析扩展版的范围综述（PRISMA-ScR）声明，在PubMed/Medline、Embase和Cochrane图书馆进行了一项范围界定的系统综述（PROSPERO编号CRD42024612152）。根据非随机研究的方法学指标（MINORS）对纳入的报告进行评审。
总体而言，分析了17项研究（13项前瞻性研究和4项回顾性研究），涉及717例患者。然而，研究的异质性和有限的长期数据阻碍了与TURP进行全面且无偏倚的比较。前列腺TPLA与12个月时LUTS的改善相关（国际前列腺症状评分[IPSS]和生活质量[QoL]的变化分别为40.7%至72.7%和50%至75%），以及患者满意度和尿流率测量值（最大尿流率[Qmax]和残余尿量的变化分别为42.8%至127.7%和28.4%至86.4%）。此外，射精功能得以保留。前列腺TPLA相关并发症发生率较低，大多数不良反应分类为Clavien-Dindo二级。
回顾性证据广泛表明，前列腺TPLA是BPH治疗的合适选择。未来需要开展研究，尤其是随机对照试验，以确认前列腺TPLA在超过标准12个月随访期的疗效，并评估其相对于TURP的成本效益。
