Transperineal Laser Ablation of Symptomatic Benign Prostatic Hyperplasia With Median‐Lobe Enlargement: A Single‐Center Experience

Objectives: 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. Methods: 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. Results: 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. Conclusion: 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.