Abstract
BackgroundTransurethral resection of the prostate (TURP) has been the standard operation for benign prostatic obstruction (BPO) for 40 years, with approximately 25,000 procedures performed annually, and has remained largely unchanged. It is generally a successful operation, but has well-documented risks for the patient. Thulium laser transurethral vaporesection of the prostate (ThuVARP) vaporises and resects the prostate using a surgical technique similar to TURP. The small amount of study data currently available suggests that ThuVARP may have certain advantages over TURP, including reduced blood loss and shorter hospital stay, earlier return to normal activities, and shorter duration of catheterisation.DesignA multicentre, pragmatic, randomised, controlled, parallel-group trial of ThuVARP versus standard TURP in men with BPO. Four hundred and ten men suitable for prostate surgery were randomised to receive either ThuVARP or TURP at four university teaching hospitals, and three district general hospitals. The key aim of the trial is to determine whether ThuVARP is equivalent to TURP judged on both the patient-reported International Prostate Symptom Score (IPSS) and the maximum urine flow rate (Qmax) at 12 months post-surgery.DiscussionThe general population has an increased life expectancy. As men get older their prostates enlarge, potentially causing BPO, which often requires surgery. Therefore, as the population ages, more prostate operations are needed to relieve obstruction. There is hence sustained interest in the condition and increasing need to find safer techniques than TURP. 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. Promising initial evidence from one RCT shows that ThuVARP has equivalent clinical effectiveness when compared to TURP, as well as other potential advantages. As ThuVARP uses a technique similar to that used in TURP, the learning curve is short, potentially making it also very quickly generalisable. This randomised study is designed to provide the high-quality evidence, in an NHS setting, with a range of patient-reported, clinical and cost-effectiveness outcomes, which will underpin and inform future NICE guidance.Trial registrationISRCTN registry, ISRCTN00788389. Registered on 20 September 2013.
Highlights
Transurethral resection of the prostate (TURP) has been the standard operation for benign prostatic obstruction (BPO) for 40 years, with approximately 25,000 procedures performed annually, and has remained largely unchanged
Various laser techniques have become available but none are widely used in the National Health Service (NHS) because of lengthy training required for surgeons or inferior performance on clinical outcomes
Promising initial evidence from one randomised controlled trial (RCT) shows that Thulium laser transurethral vaporesection of the prostate (ThuVARP) has equivalent clinical effectiveness when compared to TURP, as well as other potential advantages
Summary
Transurethral resection of the prostate (TURP) has been the standard operation for benign prostatic obstruction (BPO) for 40 years, with approximately 25,000 procedures performed annually, and has remained largely unchanged. The prostate gland sits at the exit of the bladder like a collar, and as men get older their prostates enlarge This can commonly result in either urinary retention, an inability to completely empty the bladder, or in bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO), such as slow and intermittent urinary stream. TURP has been used widely for the last 40 years, and it is generally a successful procedure, it is associated with small but significant risks It has a 30-day mortality of 0.3%, and a range of morbidities including transurethral resection (TUR) syndrome (1%), which is due to the absorption of irrigating fluid leading to confusion and collapse; haemorrhage during the operation (transfusion rate: 5%); and subsequent urinary tract infections (up to 20%) [3]. These morbidities result in delayed discharge and increased readmissions, increased primary care resource utilisation, considerable distress to patients and additional costs to the National Health Service (NHS)
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