Safety and Efficacy of Transurethral Focal Laser Ablation Versus Transurethral Resection of the Prostate in the Management of Benign Prostatic Obtruction: A Prospective Randomized Study with One Year Follow Up

Abstract Introduction and objectives: Laser ablation of prostatic adenoma has become an increasingly popular and effective alternative to transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia (BPH).-. This study focuses on assessing the safety, efficacy, and postoperative complications of Transurethral Focal Laser Ablation of Prostatic Adenoma (TU-FLAP) versus M-TURP in managing BPH, with a 12-month monitoring. Patients and Methods: 60 BPH cases meeting the inclusion criteria have randomly been assigned into 2 equal groups to undergo either TU-FLAP or M-TURP. Outcomes have been assessed using IPSS, QoL, Qmax, operative time, catheterization ,duration of hospital stay, PVR, PSA, and residual prostate volume. Safety was evaluated based on perioperative and postoperative complications. Results At the one-year follow-up, TU-FLAP resulted in significant clinical improvements, including a 78.56% reduction in IPSS, 58.8% improvement in QoL, 50% decrease in PVR, 20.48% reduction in prostate volume, and a 19.6% decrease in PSA levels. Qmax and IIEF increased by 99.67% and 47.02%, respectively. While M-TURP demonstrated superior outcomes in most functional parameters, TU-FLAP was associated with significantly shorter operative time, reduced hospital stay, and a lower incidence of postoperative complications. Notably, TU-FLAP was free of haematuria, retrograde ejaculation, and incontinence, suggesting a favorable safety profile. In contrast, retrograde ejaculation occurred in 86.96% of patients in the TURP group (Grade I; p < 0.001), representing the only statistically significant difference in adverse events. Conclusions TU-FLAP offers a promising, minimally invasive alternative to M-TURP in BPH management, with favorable outcomes, especially in patients with comorbidities, due to its shorter recovery time and lower complication rate.