Two different techniques can effectively treat lower tract symptoms
25 August 2020
New research has shown two procedures to treat men with an enlarged prostate gland are both effective. The trial compared the current ‘gold’ standard treatment of TURP (Transurethral Resection of the Prostate) to a laser technique called ThuVARP (Thulium Laser Transurethral Vaporesection of the Prostate).
The study led by the Bristol Urological Institute, a world renowned centre for urological research and urodynamics, at North Bristol NHS Trust, funded by a £1.2 million grant from the National Institute for Health Research (NIHR) and managed by the Bristol Trials Centre, is published in The Lancet.
As men get older it is common for their prostate gland to get bigger. The prostate gland sits at the exit of the bladder like a collar, so when it enlarges it can be difficult, or even impossible, for men to pass urine or can cause other bothersome urinary symptoms. 25,000 men each year have an operation to relieve this problem by reducing the size of the prostate, making it one of the most common operations performed in the NHS.
The trial was carried out as there was a suggestion that the laser procedure may result in a shorter stay in hospital following the operation, and reduced complications such as bleeding than the TURP.
There were similar improvements in patient-reported urinary symptoms at one year after surgery for both procedures. Urinary flow also improved successfully although slightly more after the TURP than the laser procedure. Men reported similar quality of life and sexual symptoms after both procedures and high satisfaction with surgery. There was no difference between the two procedures in hospital stay or complications, including bleeding. TURP was slightly more cost effective and took less time than the laser procedure.
Professor Hashim Hashim at North Bristol NHS Trust and chief investigator of the study, said: "Overall, this trial has shown that both procedures are effective for treating men with lower tract symptoms. The results will inform national guidance and ensure that men are receiving the best available treatment."
‘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’ by Prof Hashim Hashim, Jo Worthington et al in The Lancet
Bristol Urological Institute, North Bristol NHS Trust; Bristol Randomised Trials Collaboration, (Bristol Trials Centre) University of Bristol; NHS Grampian; The Newcastle upon Tyne Hospitals NHS Foundation Trust; Gloucestershire Hospitals NHS Foundation Trust; Great Western Hospitals NHS Foundation Trust and Royal Cornwall Hospitals NHS Trust
About the NIHR
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research.
- Funds, supports and delivers high quality research that benefits the NHS, public health and social care
- Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
- Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
- Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
- Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.
About Bristol Urological Institute
Bristol Urological Institute (BUI), based at Southmead Hospital Bristol, is the largest urology department in the South West and one of the largest in the country.
The BUI offers care for all urological conditions including:
- Cancers such as kidney, prostate, bladder and testis
- Stone disease of the kidney
- Incontinence problems
- Benign prostate conditions
- Erectile dysfunction.
Urology services include:
- Outpatients at Southmead Hospital, South Bristol Community Hospital and Clevedon Hospital.
- Inpatient (wards) for surgery and emergencies at Southmead Hospital.
- Urodynamic investigations for those with bladder and benign prostate conditions.
About the Bristol Trials Centre
Bristol Trials Centre (BTC) is hosted by the Faculty of Health Sciences at the University of Bristol.
We carry out:
- Randomised Controlled Trials (RCTs) and non-randomised studies to determine whether new treatments work and whether they are safe.
- Methodological research to improve the way in which we conduct RCTs and non-randomised studies.