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Abstract
Background
Transperineal laser ablation (TPLA) of the prostate is a novel, mini-invasive option for men with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH). Our aim was to assess the impact of ultrasound-guided TPLA regarding urodynamic improvement and sexual function, monitoring clinical data, postprocedural complications and imaging findings at 3-T multiparametric magnetic resonance imaging.
Methods
Forty-four patients aged ≥ 50 affected with moderate to severe LUTS (International Prostate Symptoms score ≥ 12) due to benign prostatic obstruction and refractoriness, intolerance or poor compliance to medical therapies underwent US-guided TPLA between May 2018 and February 2020. Clinical measurements included PSA, uroflowmetry, sexual function assessment (using the International Index of Erectile Function and Male Sexual Health Questionnaire-Ejaculatory Dysfunction short form) and quality of life questionnaire. Adverse events were evaluated using the Clavien-Dindo scale. Volume changes were measured by MRI and automatic segmentation software during 1-year follow-up. Registration: NCT04044573 – May 5th, 2018, https://www.clinicaltrials.gov
Results
MRI assessed the changes over time with a 53% mean reduction of adenoma volume and 71% of the ablated area, associated with clinical and functional improvement and resolution of LUTS in all cases. Five of 44 patients (11.3%) had urinary blockage due to clots and required re-catheterisation for 2 weeks. The overall adverse event rate was 7%.
Conclusion
US-guided TPLA performed as a safe, manageable and effective treatment for LUTS. It could be considered an alternative effective mini-invasive procedure to standard treatments for BPH in the outpatient setting.
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Details

1 University of Rome “Tor Vergata”, Department of Biomedicine and Prevention, Rome, Italy (GRID:grid.6530.0) (ISNI:0000 0001 2300 0941); University of Rome “Tor Vergata”, Department of Diagnostic Imaging and Interventional Radiology, Rome, Italy (GRID:grid.6530.0) (ISNI:0000 0001 2300 0941)
2 University of Rome “Tor Vergata”, Department of Biomedicine and Prevention, Rome, Italy (GRID:grid.6530.0) (ISNI:0000 0001 2300 0941)
3 Fondazione Santa Lucia IRCCS, Department of Neuromotor Physiology, Rome, Italy (GRID:grid.417778.a) (ISNI:0000 0001 0692 3437)
4 University of Rome “Tor Vergata”, Department of Urology, Rome, Italy (GRID:grid.6530.0) (ISNI:0000 0001 2300 0941)