There’s a new BPH treatment in town. Unlike minimally invasive surgery or ablation methods that access the prostatic urethra through the penis, this new approach called Transperineal Laser Ablation (TPLA) comes at reducing BPH tissue via the perineum.

I’m writing to report a journal-published review of studies that pulls together data from 17 studies, offering great news about TPLA. Before I begin, here’s a quick review of terms and abbreviations:

• Benign Prostatic Hyperplasia (BPH) – A normal noncancerous enlargement of the prostate gland due to aging. Almost all men will have some degree of BPH. This common condition can cause urination problems because the enlarging gland causes the urethra to become narrow.
• Urethra – The passage that carries urine out of the bladder toward the penis.
• Prostatic urethra – The portion of the urethra that passes directly through the prostate gland. If BPH causes the passage to become narrow, urination can become difficult.
• Lower urinary tract symptoms (LUTS) – BPH can lead to lower urinary tract symptoms (not due to other causes). These include trouble starting to pee, frequent sense of urgency, getting up often at night to pee, inability to fully empty the bladder, urinary tract infections (UTIs).
• Ablation – Minimally invasive destruction of benign tissue as an alternative to surgical removal
• Transurethral – A clinical way to deliver surgery or ablation inside the prostatic urethra by inserting instruments through the penis
• Transperineal – A clinical way to deliver outside the prostatic urethra by inserting instruments through the skin of the perineum (outer area between the scrotum and anus)

What is Transperineal Laser Ablation (TPLA)?

Transperineal Laser Ablation (TPLA) is an image-guided, minimally invasive method for ablating prostate tissue. It can be used for both focal treatment of prostate cancer tumors, and for strategic reduction of BPH growth that is blocking urine flow.

TPLA relies on a pathway through the perineum to the prostate gland. Whether for BPH or prostate cancer, the treatment is done by inserting an image-directed laser fiber into a targeted section of the prostate gland. An advantage of this pathway is a significantly lower risk of infection. Also, local anesthesia numbs the perineum as well as the prostate nerves, assuring patient comfort in addition to safety.

Thus, TPLA is an alternative to transurethral treatments like Rezum, Aquablation, UroLift, TUMT, TURP, and vaporization therapies like GreenLight Laser Therapy, HoLEP, etc. Even though TPLA uses laser, it is a different type that does not vaporize tissue, but rather coagulates it and shrinks it to harmless scar tissue. Prostate volume gradually reduces, which allows the prostatic urethra to widen naturally.

Favorable findings reported in published studies

While many patients may not be aware that it exists, it has been studied for feasibility, safety, and duration of results for nearly 10 years. A team of authors reviewed 17 high quality studies published 2017-2024 involving 777 patients (Piser et al, Mar-Apr 2026).^[i] They analyzed and averaged the data. I’m excited to report their findings on urinary function, sexual function, and prostate volume.

• Urinary function – Maximum urine flow was improved after three months of treatment, and continued to improve through the next nine months. Scores on the International Prostatic Symptom Score (IPSS) decreased significantly at only one month followup, and continued to reduce through 12 months of followup. Lower IPSS scores were linked with better quality of life.
• Sexual function – Studies that reported ejaculatory function saw no change at one month, but at three and six months, ejaculatory function was significantly improved; by 12 months, it remained stable compared to baseline. There was no significant statistical change in erectile function during the twelve months after treatment.
• Prostate volume – Prostate volume was observed to be reduced by 12 months.

In conclusion, the authors note that “TPLA demonstrated favorable outcomes for BPE without a negative impact on sexual function.” How does this compare to gold standard TURP (transurethral resection of the prostate, which some patients refer to as “reaming out”)? The team writes, “This minimally invasive treatment was found to have advantages over TURP, such as, ejaculatory function preservation, reduced operative time, and shorter hospital stay.”

TPLA at the Sperling Prostate Center

Thanks to expert Dr. Eric Walser joining our clinical team, the Sperling Prostate Center is pleased to add TPLA to our minimally invasive, MRI-guided prostate treatments. For more information, contact us.

 

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Pires IZ, Gobbo MODS, Fujimura AY Jr, Milbradt TL et al. Transperineal Laser Ablation for Treatment of Lower Urinary Tract Symptoms in Benign Prostate Enlargement: A Systematic Review and Meta-analysis. Int Braz J Urol. 2026 Mar-Apr;52(2):e20250423.