Transperineal laser ablation for 300-gram benign prostatic hyperplasia in an inoperable high-risk patient: Expanding the therapeutic horizon

Transperineal laser ablation (TPLA) is an emerging minimally invasive option for benign prostatic hyperplasia, but its role in massive glands remains undefined. We report a 78-year-old catheter-dependent man with a 300-g prostate, severe cardiopulmonary comorbidity, left ventricular ejection fraction of 25%, and mandatory dual antiplatelet therapy, making standard surgery unsafe. Total-gland TPLA was performed under local anesthesia using eight fibers and 42,300 J without complications. The patient became catheter-free after 15 days, with Qmax improving to 19.3 mL/s and prostate volume decreasing to 90 g at six months. TPLA may be feasible in selected high-risk patients with extreme BPH.