Background

TURP has been the standard operation for benign prostate obstruction (BPO) for 40 years, with ~25,000 procedures performed per year, and has remained largely unchanged. It is generally a very successful operation, but has well documented risks for the patient. Various laser techniques have become available but none are widely used in the NHS because of lengthy training required for surgeons or inferior performance on clinical outcomes.

The thulium laser technique (ThuVARP) vaporises and resects the prostate using a surgical technique similar to TURP, facilitating a shorter training period for surgeons. The small amount of study data available suggested that ThuVARP may have certain advantages over TURP. These include reduced blood loss and shorter hospital stay, earlier return to normal activities, and shorter duration of catheterization.

Aims

The key aim of this study was to determine whether ThuVARP is equivalent to TURP as treatment for men with lower urinary tract symptoms, or urinary retention, secondary to BPO.  Comparative clinical effectiveness was measured by the International Prostate Symptom Score (IPSS) and maximum urine flow rate (Qmax).  Secondary outcomes included surgical complications, length of hospital stay and cost-effectiveness.

Method