A randomized trial comparing transurethral resection of the prostate, laser therapy and conservative treatment of men with symptoms associated with benign prostatic enlargement: The CLasP study

Purpose: We evaluated the effectiveness of a new technology (noncontact las er therapy) versus that of standard surgery (transurethral prostatic resect ion) and conservative management for lower urinary tract symptoms associate d with benign prostatic enlargement. Materials and Methods: Men with uncomplicated lower urinary tract symptoms, that is no acute or chronic urinary retention, were randomized to receive laser therapy with a noncontact, side firing neodymium:YAG probe, standard transurethral prostatic resection or conservative management, including mon itoring without active intervention, in a large multicenter pragmatic rando mized controlled trial called the CLasP study. Primary outcomes were Intern ational Prostate Symptom Score (I-PSS), maximum urinary flow rate, a compos ite measure of success based on I-PSS and maximum urinary flow rate categor ies, I-PSS quality of life score and post-void residual urine volume. Secon dary outcomes included treatment failure, hospital stay and major complicat ions. Followup was 7.5 months after randomization. Intent to treat analysis was done using analysis of covariance, proportional odds models and the Ne wman-Keuls multiple comparisons procedure. Results: Of symptomatic patients 117, 117 and 106 were randomized to receiv e laser therapy, transurethral prostatic resection and conservative managem ent, respectively. Baseline characteristics were similar. All primary outco mes indicated that transurethral prostatic resection and laser therapy were superior to conservative management, and resection was superior to laser t herapy. As measured by combined improved symptoms and maximum urinary flow, a successful outcome was achieved in 81%, 67% and 15% of men who underwent transurethral prostatic resection, laser therapy and conservative manageme nt, respectively. Hospital stay was significantly shorter and complications fewer for laser therapy than for resection but catheters were in place sig nificantly longer. Men treated conservatively did not have deterioration or treatment failure. Conclusions: Laser therapy and transurethral prostatic resection are effect ive for decreasing lower urinary tract symptoms and post-void residual urin e volume as well as improving quality of life and maximum urinary flow in t he short term in men presenting with moderate to severe symptoms. Transuret hral prostatic resection is superior to laser therapy in terms of effective ness but some patients may elect laser therapy due to the shorter hospital stay and lower risk of complications. Conservative management may be accept able and safe in men with lower urinary tract symptoms since we observed no marked deterioration in the short term.