title: A prospective randomized trial comparing transurethral resection of the prostate and laser therapy in men with chronic urinary retention: The CLasP study.
abstract: OBJECTIVE
  We assessed the effectiveness of laser therapy versus transurethral prostatic resection in men with symptomatic chronic urinary retention secondary to benign prostatic enlargement.
  
  
  METHODS
  This trial was multicenter, pragmatic and randomized. Analysis was done by intent to treat. Laser therapy involved neodymium:YAG noncontact visual prostate ablation, while transurethral prostatic resection was performed by standard electroresection. Patients were included in our study if they reported moderate to severe lower urinary tract symptoms with an International Prostate Symptom Score (I-PSS) of 8 or more, benign prostatic enlargement and a persistent post-void residual urine volume of more than 300 ml. Followup was 7.5 months. Primary outcome measures included the I-PSS, I-PSS quality of life score, maximum urinary flow and post-void residual urine volume. Secondary outcome measures included treatment failure, complications, hospital stay and catheterization time.
  
  
  RESULTS
  A total of 82 patients agreed to be randomized to receive laser therapy (38) or transurethral prostatic resection (44). There were significant improvements in all primary outcomes in each group from randomization to followup. Transurethral prostatic resection was significantly better than laser therapy for I-PSS and maximum urinary flow values (p = 0.035 and 0.029, respectively) but there were no differences in post-void residual urine volume and I-PSS quality of life score between the groups. We noted significantly more treatment failures with laser therapy than resection (8 versus 0, p = 0.0014), although only 3 patients required resection after laser therapy because of persistent symptoms. In addition, hospital stay after resection was 2-fold that after laser therapy (ratio of geometric means 2.01, 95% confidence interval 1.54 to 2.61, p <0.0001). However, time to catheter removal was 9 times longer in the laser therapy group (p <0. 0001). Complication rates were significantly higher for transurethral prostatic resection (chi-square 5.05, 1 df, p = 0.025).
  
  
  CONCLUSIONS
  Transurethral prostatic resection is more effective than laser ablation in men with chronic urinary retention in terms of symptom score, maximum urinary flow and failure. However, men who underwent resection had significantly more treatment complications and were hospitalized longer than those who received laser therapy. This finding implies that laser ablation therapy may have a role in patients at higher risk who are willing to accept a lower level of effectiveness in exchange for decreased complication rates and hospital stay.
authors.affiliation: Bristol Urological Institute and Department of Social Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Gujral
authors.forename: P
authors.initials: P
authors.lastname: Abrams
authors.forename: J L
authors.initials: JL
authors.lastname: Donovan
authors.forename: D E
authors.initials: DE
authors.lastname: Neal
authors.forename: S T
authors.initials: ST
authors.lastname: Brookes
authors.forename: K N
authors.initials: KN
authors.lastname: Chacko
authors.forename: M J
authors.initials: MJ
authors.lastname: Wright
authors.forename: A G
authors.initials: AG
authors.lastname: Timoney
authors.forename: T J
authors.initials: TJ
authors.lastname: Peters
mesh_terms: D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D012720:Severity of Illness Index; D020728:Transurethral Resection of Prostate; D016055:Urinary Retention / Q000209:etiology / Q000601:surgery*