BACKGROUND: Transurethral resection of the prostate (TURP) is the standard 
operation for benign prostatic obstruction (BPO). Thulium laser transurethral 
vaporesection of the prostate (ThuVARP) vaporises and resects the prostate using 
a technique similar to TURP. The small amount of existing literature suggests 
that there may be potential advantages of ThuVARP over TURP.
OBJECTIVE: To determine whether or not the outcomes from ThuVARP are equivalent 
to the outcomes from TURP in men with BPO treated in the NHS.
DESIGN: A multicentre, pragmatic, randomised controlled parallel-group trial, 
with an embedded qualitative study and economic evaluation.
SETTING: Seven UK centres - four university teaching hospitals and three 
district general hospitals.
PARTICIPANTS: Men aged ≥ 18 years who were suitable to undergo TURP, presenting 
with bothersome lower urinary tract symptoms (LUTS) or urinary retention 
secondary to BPO.
INTERVENTIONS: Patients were randomised 1 : 1 to receive TURP or ThuVARP and 
remained blinded.
MAIN OUTCOME MEASURES: Two co-primary outcomes - patient-reported International 
Prostate Symptom Score (IPSS) and clinical measure of maximum urine flow rate 
(Qmax) at 12 months post surgery.
RESULTS: In total, 410 men were randomised, 205 to each arm. The two procedures 
were equivalent in terms of IPSS [adjusted mean difference 0.28 points higher 
for ThuVARP (favouring TURP), 95% confidence interval (CI) -0.92 to 1.49 
points]. The two procedures were not equivalent in terms of Qmax (adjusted mean 
difference 3.12 ml/second in favour of TURP, 95% CI 0.45 to 5.79 ml/second), 
with TURP deemed superior. Surgical outcomes, such as complications and blood 
transfusion rates, and hospital stay were similar for both procedures. 
Patient-reported urinary and sexual symptoms were also similar between the arms. 
Qualitative interviews indicated similar patient experiences with both 
procedures. However, 25% of participants in the ThuVARP arm did not undergo 
their randomised allocation, compared with 2% of participants in the TURP arm. 
Prostate cancer was also detected less frequently from routine histology after 
ThuVARP (65% lower odds of detection) in an exploratory analysis. The adjusted 
mean differences between the arms were similar for secondary care NHS costs (£9 
higher for ThuVARP, 95% CI -£359 to £376) and quality-adjusted life-years (0.01 
favouring TURP, 95% CI -0.04 to 0.01).
LIMITATIONS: Complications were recorded in prespecified categories; those not 
prespecified were excluded owing to variable reporting. Preoperative Qmax and 
IPSS data could not be collected for participants with indwelling catheters, 
making adjustment for baseline status difficult.
CONCLUSIONS: TURP was superior to ThuVARP in terms of Qmax, although both 
operations resulted in a Qmax considered clinically successful. ThuVARP also 
potentially resulted in lower detection rates of prostate cancer as a result of 
the smaller volume of tissue available for histology. Length of hospital stay 
after ThuVARP, anticipated to be a key benefit, was equal to that after TURP in 
this trial. Overall, both ThuVARP and TURP were effective procedures for BPO, 
with minor benefits in favour of TURP. Therefore, the results suggest that it 
may be appropriate that new treatment alternatives continue to be compared with 
TURP.
FUTURE WORK: Longer-term follow-up to assess reoperation rates over time, and 
research into the comparative effectiveness of ThuVARP and TURP in large 
prostates.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN00788389.
FUNDING: This project was funded by the National Institute for Health Research 
(NIHR) Health Technology Assessment programme and will be published in full in 
Health Technology Assessment; Vol. 24, No. 41. See the NIHR Journals Library 
website for further project information.