A prospective randomized trial comparing transurethral resection of the prostate and laser therapy in men with chronic urinary retention: The CLasP study

Purpose: We assessed the effectiveness of laser therapy versus transurethra l prostatic resection in men with symptomatic chronic urinary retention sec ondary to benign prostatic enlargement. Materials and Methods: This trial was multicenter, pragmatic and randomized . Analysis was done by intent to treat. Laser therapy involved neodymium:YA G noncontact visual prostate ablation, while transurethral prostatic resect ion was performed by standard electroresection. Patients were included in o ur study if they reported moderate to severe lower urinary tract symptoms w ith an International Prostate Symptom Score (I-PSS) of 8 or more, benign pr ostatic enlargement and a persistent post-void residual urine volume of mor e than 300 mi. Followup was 7.5 months. Primary outcome measures included t he I-PSS, I-PSS quality of life score, maximum urinary flow and post-void r esidual 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 th erapy (38) or transurethral prostatic resection (44). There were significan t improvements in all primary outcomes in each group from randomization to followup. Transurethral prostatic resection was significantly better than l aser 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 v olume and I-PSS quality of Life score between the groups. We noted signific antly more treatment failures with laser therapy than resection (8 versus 0 , p = 0.0014), although only 3 patients required resection after laser ther apy because of persistent symptoms. In addition, hospital stay after resect ion 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 re moval was 9 times longer in the laser therapy group (p <0.0001). Complicati on rates were significantly higher for transurethral prostatic resection (c hi-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 tha n those who received laser therapy. This finding implies that laser ablatio n therapy may have a role in patients at higher risk who are willing to acc ept a lower level of effectiveness in exchange for decreased complication r ates and hospital stay.