Office-based transperineal laser ablation in patients with large prostates (≥80 mL): real-world evidence of safety and efficacy from a prospective single center cohort

Transperineal laser ablation (TPLA) is emerging as a minimally invasive, office-based treatment for benign prostatic obstruction, but there is still a lack of evidence regarding its results in large prostates. The aim of this work was to evaluate safety, feasibility, and functional outcomes of TPLA in patients with prostate volume ≥80 mL. Data from consecutive patients undergoing TPLA April 2021 and February 2025 were prospectively collected in a dedicated institutional database, queried to select those patients with a prostate volume ≥80 mL who underwent TPLA. All procedures were performed under local anesthesia in an outpatient setting. A total of 234 patients underwent TPLA during the study period. Of these, 43 met the inclusion criteria for prostate volume and were included in the analysis. At the time of the surgery, 5 patients (12%) had an indwelling catheter and 36 (84%) were on medical therapy for BPO. Preoperative median prostate volume was 96 mL. At a median 12-month follow-up, uroflowmetry and symptom scores improved significantly, with preserved sexual and ejaculatory function. No major complications occurred. The catheter was successfully removed in 3 out of 5 (60%) patients with an indwelling catheter before TPLA. A total of four patients (9%) required additional surgical intervention during follow-up time. Our findings suggest that TPLA may be a safe and effective alternative to conventional surgery even in large prostates, warranting further validation through larger and comparative studies.