Laser Enucleation of Prostate (LEP) Versus Transurethral Resection of Prostate (TURP)
Laser Enucleation of Prostate (LEP) Versus Transurethral Resection of Prostate (TURP)
Benign prostatic hyperplasia (BPH) refers to the proliferation of smooth muscle and
 epithelial cells of the prostate gland. The enlarged gland has the potential to result in
 lower urinary tract symptoms (LUTS) secondary to either bladder outlet obstruction or
 increased muscle tone and resistance, or both.

 For decades transurethral resection of the prostate (TURP) has been the gold standard for
 treatment of symptomatic BPH that is refractory to nonoperative management. This is a
 surgical intervention aimed to reduce the size of the prostate gland. However, over the past
 fifteen years, many alternative therapies have been introduced including laser enucleation of
 the prostate (LEP). LEP has numerous advantages including decreased blood loss and length of
 hospital stay as well as increased effectiveness and safety for large prostate gland sizes
 (>80g).
The purpose of this study is to compare the effectiveness of TURP to LEP using the ProTouch
 laser technology. While TURP has historically been the gold standard, LEP has become more
 widespread and is arguably a safer and more effective therapy for the patient. TURP is still
 widely performed because it is a traditional therapy with decades of data to support its
 efficacy, despite higher volume of blood loss and risk for TUR syndrome. In comparison, there
 is some data demonstrating that Holmium Laser Enucleation of the Prostate can have similar
 efficacy but may have longer operative times. The ProTouch laser is comparable to the Holmium
 laser but additionally provides improved hemostasis and tissue vaporization. There is little
 to no data comparing LEP with the ProTouch laser to TURP. This study will directly compare
 the efficacy of these two treatment methods by enrolling eligible subjects and comparing
 outcomes.
Inclusion Criteria:

 -  Male

 -  Age > 50-80 years

 -  Prostate gland size 50-100g

 -  Failure of nonoperative therapy

 -  IPSS 8+

 -  FR <15ml/s

 -  PVR <250

 -  If PVR is 250-400 then pre-operative urodynamics will be indicated

 -  Language: English, Spanish, Haitian Creole, French, Portuguese

 -  Willing to randomize

 Exclusion Criteria:

 -  Neurogenic bladder

 -  PVR >400ml

 -  IPSS <8

 -  FR >15ml/Indwelling catheter

 - History of prostate cancer

 -  History of urethral stricture or vesicourethral anastomotic stricture

 -  Unable to be placed in lithotomy position

 -  Unable to undergo general or spinal anesthesia

 -  Unable to consent

 -  Untreated or uncorrected coagulopathy