Transperineal Laser Ablation for BPH-Related LUTS: Prospective Evaluation of Functional Outcomes and Predictors of Treatment Response

Purpose To prospectively evaluate the clinical and functional outcomes of Transperineal Laser Ablation (TPLA) for men with bothersome Lower Urinary Tract Symptoms (LUTS) secondary to Benign Prostatic Obstruction (BPO). Methods Consecutive patients treated with TPLA using the SoracteLite™ Echolaser system between January 2020 and February 2024 at a tertiary referral center were prospectively enrolled. Baseline prostate volume, International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and Male Sexual Health Questionnaire–Ejaculatory Dysfunction (MSHQ-EjD) scores were collected. Functional and patient-reported outcomes were assessed at 3, 6, and 12 months. Multivariable regression identified independent predictors of 12-month functional improvement. Results A total of 178 patients were included. Median prostate volume was 60 mL (IQR 40–80), and 24.2% were receiving antiplatelet or anticoagulant therapy. Median operative time was 45 minutes (IQR 30–60), and no intraoperative complications occurred. At 12 months, Qmax improved by + 3.8 mL/s, IPSS by − 12 points, MSHQ-EjD by + 4 points, and post-void residual volume by − 20 mL, with complete preservation of antegrade ejaculation in sexually active men. Acute urinary retention occurred in 14.0% of patients, mostly within the first 3 months, and five men (2.8%) underwent subsequent disobstructive surgery. Despite α-blockers being permanently discontinued in most patients, 55 men (30.9%) required reintroduction during follow-up, although urinary functional outcomes remained comparable regardless of medication status. Two patients (1.1%) required TURP for persistent voiding dysfunction. Multivariable analysis identified prostate volume, energy delivered per milliliter of prostate tissue, and baseline IPSS as independent predictors of functional improvement, with energy density emerging as the strongest determinant of treatment response. Conclusions TPLA offers a favorable safety profile and durable relief of LUTS at 12 months. Functional outcomes scale with prostate volume and energy density, supporting the relevance of energy-per-mL dosing strategies in ablative MIST platforms.