Thulium laser transurethral vaporesection of the prostate (ThuVARP) for benign prostatic hyperplasia (BPH) appears similarly effective to transurethral resection of the prostate (TURP) at improving urinary symptoms,, according to data from the UNBLOCS trial published in The Lancet.

In the trial, investigators randomly assigned 410 blinded patients with lower urinary tract symptoms (LUTS) or urinary retention to undergo ThuVARP or TURP (monopolar or bipolar). Each group had 205 patients. Surgeons were trained on the ThuVARP technique (5 to 12 procedures) and judged competent by an independent assessor. ThuVARP vaporizes and resects the prostate using a thulium-yttrium aluminum garnet fiber that delivers light with a 2000 nm wavelength, according to background information provided by the authors. Similar to TURP, the technique allows visual resection in chips.

TURP yielded superior maximum urinary flow rate (Qmax) at 12 months after surgery: mean 23.2 vs 20.2 mL/s, Hashim Hashim, MBBS, MD, of Southmead Hospital in Bristol, UK, and collaborators reported. Both procedures yielded an equally low International Prostate Symptom Score (IPSS) at 12 months: mean 6.3 for TURP vs 6.4 for ThuVARP. Although the proportion of patients experiencing nocturia (more than 1 urination per night) at 12 months was slightly lower in the TURP than ThuVARP group (37% vs 44%), the difference between the groups was not statistically significant.

Nearly half of both groups experienced at least 1 complication: 45% of TURP vs 47% of ThuVARP patients. No one experienced transurethral resection syndrome. Despite expectations, ThuVARP did not significantly reduce blood loss or shorten hospital stay compared with TURP. Blood loss was -8 for TURP and -6 g/L for ThuVARP, and 2% of each group required transfusion. Mean hospital stay was 48 hours for both study groups. Nine patients were converted to TURP because of a large prostate.


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With respect to erectile dysfunction, 74% of TURP vs 70% of ThuVARP patients had reduced or no erections at 12 months.

“Our trial results could be used to update the literature and urology guidelines, allowing patients to be more informed at the point of consent on the risks and benefits of such procedures, especially with regard to side-effects,” Dr Hashim’s team stated.

 “The UNBLOCS trial is a much awaited and well-designed trial that evaluates the efficacy and side effects of two surgical approaches to treat lower urinary tract symptoms due to benign prostatic obstruction in a setting that reflects daily clinical practice,” Giuseppe Magistro, MD, and Christian Stief, MD, of Ludwig Maximilian University of Munich in Munich, Germany, wrote in an accompanying editorial. “These results will help improve individual patient care and patient treatment patterns in urological departments and the guidelines of various scientific associations.”

They notedthat ultimately the study compared “well done TURP with somewhat suboptimal ThuVARP” because surgical performance was not objectively evaluated, which may have affected outcomes such as Qmax.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

References

Hashim H, Worthington J, Abrams P, et al. 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 [published online July 4, 2020]. Lancet.

Magistro G,Stief CG. Surgery for benign prostatic obstruction [published online July 4, 2020]. Lancet.