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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.
J Urol. 2000 Jul; 164(1):65-70.JU

Abstract

PURPOSE

We evaluated the effectiveness of a new technology (noncontact laser therapy) versus that of standard surgery (transurethral prostatic resection) and conservative management for lower urinary tract symptoms associated 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 monitoring without active intervention, in a large multicenter pragmatic randomized controlled trial called the CLasP study. Primary outcomes were International Prostate Symptom Score (I-PSS), maximum urinary flow rate, a composite measure of success based on I-PSS and maximum urinary flow rate categories, I-PSS quality of life score and post-void residual urine volume. Secondary outcomes included treatment failure, hospital stay and major complications. Followup was 7.5 months after randomization. Intent to treat analysis was done using analysis of covariance, proportional odds models and the Newman-Keuls multiple comparisons procedure.

RESULTS

Of symptomatic patients 117, 117 and 106 were randomized to receive laser therapy, transurethral prostatic resection and conservative management, respectively. Baseline characteristics were similar. All primary outcomes indicated that transurethral prostatic resection and laser therapy were superior to conservative management, and resection was superior to laser therapy. 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 management, respectively. Hospital stay was significantly shorter and complications fewer for laser therapy than for resection but catheters were in place significantly longer. Men treated conservatively did not have deterioration or treatment failure.

CONCLUSIONS

Laser therapy and transurethral prostatic resection are effective for decreasing lower urinary tract symptoms and post-void residual urine volume as well as improving quality of life and maximum urinary flow in the short term in men presenting with moderate to severe symptoms. Transurethral prostatic resection is superior to laser therapy in terms of effectiveness but some patients may elect laser therapy due to the shorter hospital stay and lower risk of complications. Conservative management may be acceptable and safe in men with lower urinary tract symptoms since we observed no marked deterioration in the short term.

Authors+Show Affiliations

Department of Social Medicine, University of Bristol and Bristol Urological Institute, Bristol, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10840426

Citation

Donovan, J L., et al. "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." The Journal of Urology, vol. 164, no. 1, 2000, pp. 65-70.
Donovan JL, Peters TJ, Neal DE, et al. 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. J Urol. 2000;164(1):65-70.
Donovan, J. L., Peters, T. J., Neal, D. E., Brookes, S. T., Gujral, S., Chacko, K. N., Wright, M., Kennedy, L. G., & Abrams, P. (2000). 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. The Journal of Urology, 164(1), 65-70.
Donovan JL, et al. 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. J Urol. 2000;164(1):65-70. PubMed PMID: 10840426.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Donovan,J L, AU - Peters,T J, AU - Neal,D E, AU - Brookes,S T, AU - Gujral,S, AU - Chacko,K N, AU - Wright,M, AU - Kennedy,L G, AU - Abrams,P, PY - 2000/6/7/pubmed PY - 2000/7/15/medline PY - 2000/6/7/entrez SP - 65 EP - 70 JF - The Journal of urology JO - J Urol VL - 164 IS - 1 N2 - PURPOSE: We evaluated the effectiveness of a new technology (noncontact laser therapy) versus that of standard surgery (transurethral prostatic resection) and conservative management for lower urinary tract symptoms associated 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 monitoring without active intervention, in a large multicenter pragmatic randomized controlled trial called the CLasP study. Primary outcomes were International Prostate Symptom Score (I-PSS), maximum urinary flow rate, a composite measure of success based on I-PSS and maximum urinary flow rate categories, I-PSS quality of life score and post-void residual urine volume. Secondary outcomes included treatment failure, hospital stay and major complications. Followup was 7.5 months after randomization. Intent to treat analysis was done using analysis of covariance, proportional odds models and the Newman-Keuls multiple comparisons procedure. RESULTS: Of symptomatic patients 117, 117 and 106 were randomized to receive laser therapy, transurethral prostatic resection and conservative management, respectively. Baseline characteristics were similar. All primary outcomes indicated that transurethral prostatic resection and laser therapy were superior to conservative management, and resection was superior to laser therapy. 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 management, respectively. Hospital stay was significantly shorter and complications fewer for laser therapy than for resection but catheters were in place significantly longer. Men treated conservatively did not have deterioration or treatment failure. CONCLUSIONS: Laser therapy and transurethral prostatic resection are effective for decreasing lower urinary tract symptoms and post-void residual urine volume as well as improving quality of life and maximum urinary flow in the short term in men presenting with moderate to severe symptoms. Transurethral prostatic resection is superior to laser therapy in terms of effectiveness but some patients may elect laser therapy due to the shorter hospital stay and lower risk of complications. Conservative management may be acceptable and safe in men with lower urinary tract symptoms since we observed no marked deterioration in the short term. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/10840426/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5347(05)67450-2 DB - PRIME DP - Unbound Medicine ER -