World Journal of Urology | 2021
Comment on: Thulium laser transurethral vaporesection versus transurethral resection of the prostate for benign prostatic obstruction: the UNBLOCS RCT
Abstract
We read the paper entitled “Thulium laser transurethral vaporesection versus transurethral resection of the prostate for benign prostatic obstruction: the UNBLOCS RCT” [1]. This multicentre randomized controlled trial compares clinical and functional outcomes between transurethral resection of the prostate (TURP) and thulium laser vaporesection of the prostate (ThuVARP), with an embedded qualitative and economic evaluation. The authors conclude that both procedures are effective for the treatment of benign prostatic obstruction, with similar improvement in IPSS. However, TURP determined higher Qmax, shorter operative time and allowed the resection of a larger amount of tissue, resulting in higher detection of prostate cancer. We congratulate the authors for their work, the statistical analysis, the effective blinding of participants, the economic evaluation and the qualitative analysis that were carried out. However, we would like to address some issues. With regard to patient assessment, no objective preoperative prostatic volume evaluation was performed. Prostatic volume was only estimated by digital rectal examination. It is clear how such means of examination is affected by excessive subjectivity, imprecision and inaccuracy. Moreover, it does not allow to verify homogeneity of the two groups and to adequately compare volume-related variables, such as operative time and quality of resection (ratio between resected tissue and preoperative prostatic volume). Prostatic volume should have been objectively assessed with at least some form of imaging, such as transrectal ultrasonography (TRUS), to: