Quick answer
EchoLaser is ultrasound-guided laser ablation of the prostate through the perineum. Fine needles carry laser fibers into the prostate, and the heat coagulates the tissue at a safe distance from the urethra.1,5 The European guideline still treats the technique as under evaluation.1 More than 85% of men kept their ejaculation.1
How it is done
- NeedlesFine needles go in through the perineum, the area between the scrotum and the anus, guided by ultrasound.1
- LaserA fiber runs inside each needle and fires the laser inside the prostate.1
- CoagulationThe heat coagulates the tissue around the fiber, away from the urethra and the bladder neck.5
- Following monthsThe prostate shrinks and the urinary channel opens gradually. In one series, the results kept improving up to 6 months.5
In my practice, the treatment is done under local anesthesia and sedation, with no hospital stay: once it is done, you go home. The catheter stays for 5 to 7 days. In the studies, most men were treated under local anesthesia and went home within 24 hours.1 In a series of 21 men, the catheter stayed for 8.7 days on average.5
Who it is for
The European guideline lists EchoLaser among the techniques under evaluation, and the studies still have shorter follow-up than those of traditional surgery.1 It does not name a prostate weight for the technique. In practice, this has to be assessed case by case. If preserving ejaculation matters to you, this option is worth considering.
What the studies show
| Source | Patients | Result |
|---|---|---|
| Pires, 2026 | 17 studies, 777 men | At 12 months: IPSS 12.6 points lower, stream 6.3 mL/s stronger and prostate 21 g smaller3 |
| Alberti, 2026 | 17 studies | No major adverse events; follow-up of up to 5 years2 |
| Studies against TURP | Two randomized studies | Stronger stream with TURP: an increase of 23.9 versus 6.0 mL/s in one of them1 |
Relief was smaller than with TURP, and that is part of the decision.1,4
Risks
Complications were mostly mild, and major ones stayed below 5%.1 Temporary urinary retention, urinary infection and pain in the perineum can occur.1 In one series, one man had a prostate abscess.5
Erections and ejaculation
More than 85% of men kept their ejaculation in the European guideline.1 In a review of minimally invasive techniques, loss of ejaculation was 5%.6
How I approach it
In my practice, I look at the size of the prostate, your symptoms and what you want to preserve. I compare EchoLaser with the other options and explain that relief tends to be smaller than with surgery that removes tissue, and that the improvement takes months.
When to see a urologist
- If you have an enlarged prostate and medications do not bring enough relief
- If preserving ejaculation weighs on your decision
- If you want to compare EchoLaser with other techniques
- After treatment, if you have fever, severe pain or difficulty urinating
Frequently asked questions
What is EchoLaser?+
It is laser ablation of the prostate through the perineum, the area between the scrotum and the anus. Fine needles, guided by ultrasound, carry laser fibers into the prostate.1
Does EchoLaser go through the urethra?+
No. The needles go in through the perineum, and the treatment is planned to keep a safe distance from the urethra and the bladder neck.1,5
Does EchoLaser preserve ejaculation?+
In the European guideline, more than 85% of men kept their ejaculation.1 In a review of minimally invasive techniques, loss of ejaculation was 5%.6
Will I need to stay in hospital?+
Not in my practice. EchoLaser is done under local anesthesia and sedation, you go home when the procedure is over, and the catheter stays for 5 to 7 days. In the studies, most men were treated under local anesthesia and went home within 24 hours.1
Are the results the same as TURP?+
No. In two randomized studies, TURP gave a stronger stream, and in one of them the drop in IPSS was twice as large.1
How long does it take to improve?+
The improvement comes gradually. In a series of 21 men, the results kept improving up to 6 months.5
References
- EAU Guidelines on the Management of Non-neurogenic Male LUTS. European Association of Urology; 2026. Disease management chapter. EAU
- Alberti A, Lo Re M, Nicoletti R, et al. Transperineal laser ablation in the management of benign prostatic hyperplasia: an updated systematic review and pooled analysis. Prostate Cancer Prostatic Dis. 2026;29(2):222-238. PubMed
- Pires IZ, Gobbo MODS, Fujimura AY, 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;52(2). PubMed
- Canat HL, Gurbuz C, Bozkurt M, et al. Transurethral resection of the prostate (TURP) versus transperineal laser ablation (TPLA) due to benign prostatic hyperplasia (BPH): prospective and comparative study. Int Urol Nephrol. 2023;55(11):2747-2752. PubMed
- de Rienzo G, Lorusso A, Minafra P, et al. Transperineal interstitial laser ablation of the prostate, a novel option for minimally invasive treatment of benign prostatic obstruction. Eur Urol. 2021;80(1):95-103. PubMed
- Franco A, Ditonno F, Manfredi C, et al. Systematic Review and Pooled Analysis of Functional and Sexual Outcomes of Minimally Invasive Surgical Treatments for Benign Prostatic Obstruction. Eur Urol. 2026;89(4):318-331. PubMed
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