Transperineal Laser Ablation for Treatment of Lower Urinary Tract Symptoms in Benign Prostate Enlargement: A Systematic Review and Meta-analysis

PURPOSE: This is a systematic review and meta-analysis of the outcomes of transperineal prostate laser ablation (TPLA) in men with benign prostatic enlargement. MATERIALS AND METHODS: Pubmed, Embase, Scopus, and Cochrane Library databases were searched from inception to July 2024. Random-effects model was employed to compute mean differences for continuous endpoints. Heterogeneity was evaluated by prediction interval and I-squared statistics. Results were reported following the PRISMA guidelines. RESULTS: Seventeen studies involving 777 patients with mean age of 62 to 80 years were included. Over 12-month follow-up, TPLA decreased the International Prostate Symptom Score (MD -12.62; 95% CI -14.87 to -10.37; p<0.001; I2 = 90%), post-void residual (MD -73.24 mL; 95% CI -96.91 to -49.57; p<0.001; I2 = 89%), and prostate volume (MD -21.23 mL; 95% CI -32.65 to -9.81; p<0.001; I2 = 84%). TPLA increased the maximum urinary flow rate (MD 6.32 mL/s; 95% CI 4.69 to 7.95; p<0.001; I2 = 81%). Ejaculatory and erectile functions were not impacted. Compared to TURP, TPLA was associated with ejaculatory function preservation, shorter operating time and length of stay. Risk of bias for the non-randomized studies was moderate, and low for the randomized studies. CONCLUSIONS: TPLA demonstrated favorable outcomes for BPE without a negative impact on sexual function. This minimally invasive treatment was found to have advantages over TURP, such as, ejaculatory function preservation, reduced operative time, and shorter hospital stay. Evidence for this MIST is emerging but remains predominantly retrospective with short follow-up, highlighting the need for further comparative prospective studies.