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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

2000; Lippincott Williams & Wilkins; Volume: 164; Issue: 1 Linguagem: Inglês

10.1016/s0022-5347(05)67450-2

1527-3792

Jenny Donovan, T. J. Peters, David E. Neal, Sara Brookes, Sandeep Gujral, K. NINAN CHACKO, Mark Wright, L G Kennedy, Paul Abrams,

Pelvic floor disorders treatments

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jul 2000A 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 JENNY L. DONOVAN, TIM J. PETERS, DAVID E. NEAL, SARA T. BROOKES, SANDEEP GUJRAL, K. NINAN CHACKO, MARK WRIGHT, L. GAIL KENNEDY, and PAUL ABRAMS JENNY L. DONOVANJENNY L. DONOVAN , TIM J. PETERSTIM J. PETERS , DAVID E. NEALDAVID E. NEAL , SARA T. BROOKESSARA T. BROOKES , SANDEEP GUJRALSANDEEP GUJRAL , K. NINAN CHACKOK. NINAN CHACKO , MARK WRIGHTMARK WRIGHT , L. GAIL KENNEDYL. GAIL KENNEDY , and PAUL ABRAMSPAUL ABRAMS View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67450-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail 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. References 1 : High prevalence of benign prostatic hypertrophy in the community. Lancet1991; 338: 469. Google Scholar 2 : The prevalence of prostatism: a population-based survey of urinary symptoms. J Urol1993; 150: 85. Link, Google Scholar 3 : Urinary symptoms in the community: how bothersome are they?. Br J Urol1994; 74: 551. Google Scholar 4 : Prostatectomy for benign prostatic hyperplasia. In: . New York: Radcliffe Medical Press1994: 140. Google Scholar 5 : The National Prostatectomy Audit: the clinical management of patients during hospital admission. Br J Urol1995; 75: 301. Google Scholar 6 : A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. New Engl J Med1995; 332: 75. Google Scholar 7 : Benign Prostatic Hyperplasia: Diagnosis and Treatment. Clinical Practice Guideline. Rockville, Maryland: United States Department of Health and Human Services, Agency for Health Care Policy and Research1994. Google Scholar 8 : Treatment for Benign Prostatic Hyperplasia: A Systematic Review. Bristol: University of Bristol1996. Google Scholar 9 : Watchful waiting vs immediate transurethral resection for symptomatic prostatism. The importance of patients' preferences. JAMA1988; 259: 3010. Google Scholar 10 : Laser therapy for benign prostatic hyperplasia. Curr Opin Urol1993; 3: 16. Google Scholar 11 : Laser prostatectomy performed with a right angle firing neodymium: YAG laser fiber at 40 watts power setting. J Urol1993; 150: 95. Link, Google Scholar 12 : A multicenter, randomized, prospective study of endoscopic laser ablation versus transurethral resection of the prostate. Urology1995; 46: 305. Google Scholar 13 : A prospective randomized comparison of transurethral resection to visual laser ablation of the prostate for the treatment of benign prostatic hyperplasia. Urology1995; 46: 155. Google Scholar 14 : Comparative study of laser versus electrocautery prostatic resection: 18-month followup with complex urodynamic assessment. J Urol1995; 153: 94. Link, Google Scholar 15 : The Oxford Laser Prostate Trial: a double-blind randomized controlled trial of contact vaporization of the prostate against transurethral resection: preliminary results. Br J Urol1996; 77: 382. Google Scholar 16 : The assessment of prostatic obstruction from urodynamic measurements and from residual urine. Br J Urol1979; 51: 129. Google Scholar 17 : Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA1996; 276: 637. Google Scholar 18 : Better reporting of randomised controlled trials: the CONSORT statement. BMJ1996; 313: 570. Google Scholar 19 : Recommendations of the International Consensus Committee. In: . New Jersey: Scientific International1991. Google Scholar 20 : Dosimetry studies utilizing the urolase right-angle firing neodymium: YAG laser fiber in the human prostate. Lasers Surg Med1996; 18: 72. Google Scholar 21 : Benign prostatic hyperplasia specific health status measures in clinical research: how much change in the American Urological Association symptom index and the benign prostatic hyperplasia impact index is perceptible to patients?. J Urol1995; 154: 1770. Link, Google Scholar 22 : Statistical Methods in Medical Research. Boston: Blackwell1994. Google Scholar 23 : Ordinal logistic regression in medical research. J R Coll Physicians of Lond1997; 31: 546. Google Scholar 24 : Controversies about indications for transurethral resection of the prostate. J Urol1989; 141: 475. Link, Google Scholar 25 : TULIP: transurethral ultrasound-guided laser-induced prostatectomy. Clinical results after one year TULIP. Urol (Paris)1993; 99: 61. Google Scholar From the Department of Social Medicine, University of Bristol and Bristol Urological Institute, Bristol and Department of Surgical Sciences, University of Newcastle, Newcastle-upon-Tyne, United Kingdom© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byErol A, Cam K, Tekin A, Memik O, Coban S and Ozer Y (2018) High Power Diode Laser Vaporization of the Prostate: Preliminary Results for Benign Prostatic HyperplasiaJournal of Urology, VOL. 182, NO. 3, (1078-1082), Online publication date: 1-Sep-2009.TOOHER R, SUTHERLAND P, COSTELLO A, GILLING P, REES G and MADDERN G (2018) A Systematic Review of Holmium Laser Prostatectomy for Benign Prostatic HyperplasiaJournal of Urology, VOL. 171, NO. 5, (1773-1781), Online publication date: 1-May-2004.HOFFMAN R, MacDONALD R, SLATON J and WILT T (2018) Laser Prostatectomy Versus Transurethral Resection for Treating Benign Prostatic Obstruction: A Systematic ReviewJournal of Urology, VOL. 169, NO. 1, (210-215), Online publication date: 1-Jan-2003.NOBLE S, COAST J, BROOKES S, NEAL D, ABRAMS P, PETERS T and DONOVAN J (2018) Transurethral Prostate Resection, Noncontact Laser Therapy or Conservative Management in Men With Symptoms of Benign Prostatic Enlargement? An Economic EvaluationJournal of Urology, VOL. 168, NO. 6, (2476-2482), Online publication date: 1-Dec-2002.Dotan Z, Mor Y, Leibovitch I, Varon D, Golomb J, Duvdevani M and Ramon J (2018) The Efficacy and Safety of Perioperative Low Molecular Weight Heparin Substitution in Patients on Chronic Oral Anticoagulant Therapy Undergoing Transurethral Prostatectomy for Bladder Outlet ObstructionJournal of Urology, VOL. 168, NO. 2, (610-614), Online publication date: 1-Aug-2002.ŞENGÖR F, GÜRDAL M, TEKIN A, YÜCEBAŞ E, BEYSEL M and ERDOĞAN K (2018) NEODYMIUM: YAG VISUAL LASER ABLATION OF THE PROSTATE: 7 YEARS OF EXPERIENCE WITH 230 PATIENTSJournal of Urology, VOL. 167, NO. 1, (184-187), Online publication date: 1-Jan-2002.CHACKO K, DONOVAN J, ABRAMS P, PETERS T, BROOKES S, THORPE A, GUJRAL S, WRIGHT M, KENNEDY L and NEAL D (2018) TRANSURETHRAL PROSTATIC RESECTION OR LASER THERAPY FOR MEN WITH ACUTE URINARY RETENTION: THE CLASP RANDOMIZED TRIALJournal of Urology, VOL. 166, NO. 1, (166-171), Online publication date: 1-Jul-2001.DONOVAN J, PETERS T, ABRAMS P, BROOKES S, DE LA ROSETTE J and SCHÄFER W (2018) SCORING THE SHORT FORM ICSmaleSF QUESTIONNAIREJournal of Urology, VOL. 164, NO. 6, (1948-1955), Online publication date: 1-Dec-2000. Volume 164Issue 1July 2000Page: 65-70 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordsprostatectomyprostateprostatic neoplasmsprostatic hyperplasiaMetricsAuthor Information JENNY L. DONOVAN More articles by this author TIM J. PETERS More articles by this author DAVID E. NEAL More articles by this author SARA T. BROOKES More articles by this author SANDEEP GUJRAL More articles by this author K. NINAN CHACKO More articles by this author MARK WRIGHT More articles by this author L. GAIL KENNEDY More articles by this author PAUL ABRAMS More articles by this author Expand All Advertisement PDF downloadLoading ...