TURP by Thulium laser as effective as conventional TURP for BHP

The researchers conducted a randomized, blinded, parallel-group, pragmatic equivalence trial. It included men in 7 UK hospitals with bothersome lower urinary tract symptoms or urinary retention secondary to benign prostatic obstruction. They were randomly assigned in the ratio 1:1 at the point of surgery to receive ThuVARP or TURP. Between July 23, 2014, and Dec 30, 2016, 410 men were randomly assigned to ThuVARP or TURP, 205 per study group.

Patients were masked until follow-up completion. Centres used their usual TURP procedure (monopolar or bipolar).

Co-primary outcomes were maximum urinary flow rate (Qmax) and International Prostate Symptom Score (IPSS) at 12-months post-surgery. Equivalence was defined as a difference of 2·5 points or less for IPSS and 4 mL per s or less for Qmax. Analysis was done according to the intention-to-treat principle. 

"TURP and ThuVARP were equivalent for urinary symptom improvement (IPSS) 12-months post-surgery, and TURP was superior for Qmax. Anticipated laser benefits for ThuVARP of reduced hospital stay and complications were not observed," concluded the authors. "Our results suggest that it is appropriate that new treatment alternatives continue to be compared with the current standard of TURP, as per NICE guidelines," they wrote.

The study, "Thulium laser transurethral vaporesection of the prostate versus transurethral resection of the prostate for men with lower urinary tract symptoms or urinary retention (UNBLOCS): a randomised controlled trial," is published in The Lancet.

DOI: https://doi.org/10.1016/S0140-6736(20)30537-7