Ejaculatory function following transperineal laser ablation vs TURP for benign prostatic obstruction: a randomized trial

Objectives To evaluate the reliability of transperineal interstitial laser ablation of the prostate (TPLA) in preserving antegrade ejaculation compared to transurethral resection of the prostate (TURP). Patients and Methods In this single‐centre, prospective, randomized, open‐label study, consecutive patients with indication for surgical treatment for benign prostatic obstruction (BPO) were enrolled between January 2020 and September 2021 (NCT04781049). Patients were randomized to one of two treatment arms: Group A: TPLA (experimental group) and Group B: TURP (reference standard group). The primary endpoint was change in ejaculatory function (assessed by the Male Sexual Health Questionnaire – Ejaculatory function domain [EJ‐MSHQ]) at 1 month after surgery. Secondary endpoints included comparison of visual analogue scale (VAS) scores, changes in sexual function (assessed using the five‐item International Index of Erectile Function [IIEF‐5]), change in International Prostate Symptom Score [IPSS], change in quality of life score, and maximum urinary flow rate [ Q max ] improvement at 1–6 months, as appropriate. Results Fifty‐one patients (26 TPLA vs 25 TURP) were analysed. No differences in the perception of pain assessed by VAS and no differences in IIEF‐5 score were found between the groups. The distribution of ejaculatory function assessed by the EJ‐MSHQ remained unmodified after TPLA ( P = 0.2), while a median 30% decrease in EJ‐MSHQ score was observed after TURP ( P = 0.01). Absence of antegrade ejaculation was reported in one patient in the TPLA group (vs 18 patients in the TURP group). A statistically significant difference between the treatment groups was found in terms of postoperative Q max (TPLA vs TURP: 15.2 [interquartile range 13.5–18.3] mL/s vs 26.0 [interquartile range 22.0–48.0] mL/s; P < 0.001). Both treatments significantly improved Q max , with a mean 23.9 mL/s improvement after TURP (95% confidence interval [CI] 17.1–30.7) vs 6.0 mL/s after TPLA (95% CI 5.0–7.0), and IPSS, with a mean decrease of 11.6 (95% CI 9.7–13.5) vs 5.8 after TPLA (95% CI.2–9.6) with respect to baseline. Conclusion In our study, TPLA preserved ejaculatory function in 96% of cases in addition to providing significant relief from BPO.