Thulium laser transurethral vaporesection of the prostate versus transurethral resection of the prostate: Results of the UNBLOCS randomized controlled trial

Introduction & Objectives: Transurethral resection of the prostate (TURP), using electro-cautery, is the commonest surgical procedure for benign prostatic obstruction (BPO). Thulium-laser transurethral vaporesection of the prostate (ThuVARP)is a relatively new technique which vaporises and resects the prostate similarly to TURP (i.e. resectoscope hand-movement)with histology samples. The limited literature suggests advantages of laser techniques in terms of length of stay and bleeding. This NIHR-funded study aimed to determine whether ThuVARP is equivalent to TURP for BPO treatment. Materials & Methods: This randomized controlled, parallel-group, blinded phase III trial was conducted in seven NHS UK centres. Men presenting with voiding LUTS or urinary retention secondary to BPO were randomized to TURP or ThuVARP. The co-primary outcomes were the IPSS and maximum urinary flow rate (Qmax)at 12 months. Secondary outcomes included complications (Clavien-Dindo), healthcare costs and patient experiences. Results: Overall, 410 men were randomized (205 per arm). IPSS scores reduced equally for both procedures with a small benefit for TURP in Qmax (Table 1). Surgical complications, transfusion rates and hospital stay were similar for both procedures. Patient experiences (37 interviews)and urinary and sexual outcome measures were similar across treatments. Notably, only 75% of ThuVARP patients underwent their allocation versus 98% for TURP, mostly due to ThuVARP equipment failure (18/51). In an exploratory analysis, prostate cancer was detected incidentally less frequently after ThuVARP (13% vs. 5%, OR 0.35, 95% CI: 0.16-0.75). ThuVARP took 20 minutes on average longer than TURP. Costs were similar, at £4185 for TURP and £67 higher for ThuVARP (95% CI: -£353 to £486). [Table Presented]Conclusions: ThuVARP mostly demonstrated similar outcomes to TURP. TURP was superior for Qmax, although both were clinically successful. ThuVARP also detected less prostate cancer, incidentally. The anticipated benefits of length of stay and bleeding for ThuVARP were equal to TURP. Overall, ThuVARP and TURP are effective BPO treatments, with minor clinical benefits favouring TURP.