Interventional procedure overview of image-guided transperineal laser ablation (TPLA) for treating lower urinary tract symptoms caused by benign prostatic hyperplasia

What the procedure involves

The procedure uses a percutaneous transperineal approach to ablate the prostate with laser energy. The aim is to reduce the prostate volume, leading to a reduction in urinary tract symptoms.

The procedure can be done as a day-case procedure under general, local or regional anaesthesia with or without sedation. Continuous saline irrigation of the urethra and bladder is done with a catheter in place during the entire procedure. The person having the procedure is placed in a lithotomy position. Using TRUS guidance and real-time monitoring using a dedicated software planning tool, one or two 21‑gauge introducer needles per lobe (depending on the basal volume and shape of the prostatic gland) are inserted transperineally into the prostatic tissue. A laser fibre is then introduced through the needle.

Low powers (3 to 5 watts) and low laser light energy (up to 1800 J per fibre and illumination) is delivered from the diode laser system for several minutes to heat and destroy the prostate tissue around the tip of the fibre, according to a standard protocol. If needed, a second illumination can be done to treat a larger area. The maximum volume treated in a session and the extent of the ablation vary according to the prostatic volume, anatomy and surgeon preference.