Benign prostatic hyperplasia (BPH) with median-lobe enlargement (MLE) is a distinct and challenging clinical entity contributing to lower urinary tract symptoms (LUTS). Minimally invasive treatments, such as transperineal laser ablation (TPLA), offer potential advantages in treating this subgroup, but limited data exist regarding their outcomes. The aim of this study is to evaluate the efficacy and safety of EchoLaser TPLA of symptomatic BPH with MLE.
This study retrospectively evaluated 31 patients with symptomatic BPH and MLE who underwent EchoLaser TPLA at a private clinic. EchoLaser TPLA was performed with a proprietary 1064-nm continuous-wave diode laser. Baseline and 6-month follow-up assessments included International Prostate Symptom Score (IPSS), quality of life (QoL), prostate volume (PV), postvoid residual (PVR), peak urinary flow rate (Qmax), and International Index of Erectile Function (IIEF-15). Safety outcomes were categorized using the Clavien-Dindo classification system.
EchoLaser TPLA significantly improved IPSS (median 22 to 6.5; p < 0.001), QoL (median 5 to 1; p < 0.001), PV (median 105 mL to 43 mL; p < 0.001), PVR (median 120 mL to 23.5 mL; p < 0.001), and Qmax (median 7.6 mL/s to 15.95 mL/s; p < 0.001) at 6 months. IIEF-15 scores remained stable, indicating preservation of erectile function. No intraoperative adverse events occurred; two mild periprocedural events (urinary tract infection, hematuria) were successfully managed conservatively. Nine of 10 catheter-dependent patients resumed normal voiding.
EchoLaser TPLA is an effective and safe minimally invasive treatment for BPH with MLE, offering significant symptomatic relief, functional improvement, and a favorable safety profile while preserving sexual function. These findings position EchoLaser TPLA as a promising alternative to conventional treatments for this challenging patient subgroup.
Lasers in surgery and medicine. 2026 May 18 [Epub ahead of print]
Antonio Ruffo, Nikola Stanojevic, Felice Crocetto, Biagio Barone, Petr Holy, Vincenzo Maria Altieri, Lorenzo Spirito, Fabio Esposito
Department of Medicine and Health Sciences ''V. Tiberio'', University of Molise, Campobasso, Italy., Urogenital Center, Belgrade, Serbia., Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, Ospedale San Paolo, ASL NA1, Naples, Centro, Italy., Urosante, Prague, Czech Republic., Department of Woman, Child and General and Specialized Surgery, Unit of Urology, University of Campania "Luigi Vanvitelli", Napoli, Italy., Casa di Cura Nostra Signora di Lourdes, Napoli, Italy.