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Thulium Laser Enucleation With Bladder Neck Incision for Small-Volume Benign Prostatic Hyperplasia (ThuLEP-BNI)

18. juli 2026 opdateret af: Qing Yuan, Chinese PLA General Hospital

Thulium Laser Enucleation of the Prostate Combined With Bladder Neck Incision for Small-Volume Benign Prostatic Hyperplasia: A Multicentre, Randomized, Single-Blind, Four-Arm Controlled Trial

This study will evaluate the safety and effectiveness of different surgical treatments for men with small-volume benign prostatic hyperplasia (BPH). Men with small-volume BPH may still have bothersome lower urinary tract symptoms and bladder outlet obstruction, and the best surgical treatment for this group remains uncertain.

In this multicentre, randomized, single-blind, four-arm controlled trial, 932 eligible men aged 40 to 80 years will be assigned in a 1:1:1:1 ratio to one of four groups: thulium laser enucleation of the prostate combined with bladder neck incision, thulium laser enucleation of the prostate alone, transurethral resection of the prostate (TURP), or transurethral incision of the prostate (TUIP).

The main goal of the study is to compare the incidence of bladder neck contracture at 6 months after surgery. Secondary outcomes include safety outcomes and changes in urinary symptoms, urinary flow rate, pain score, and symptom response at 3 and 6 months after surgery. Exploratory outcomes include changes in post-void residual urine volume and sexual function scores. Additional exploratory long-term outcomes will also be assessed at 12 months after surgery.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Benign prostatic hyperplasia (BPH) is a common condition in aging men and may lead to bladder outlet obstruction and lower urinary tract symptoms. In some patients, clinically significant obstruction and symptoms can occur even when prostate volume is relatively small. Small-volume BPH should not necessarily be regarded as a mild condition, because these patients may still experience bothersome symptoms, impaired urinary flow, increased post-void residual urine volume, and bladder outlet obstruction. In this subgroup, obstruction may be related not only to adenomatous enlargement, but also to an elevated, narrow, or fibrotic bladder neck. Surgical treatment of small-volume BPH remains challenging, and the optimal surgical approach has not been clearly established.

This study is a multicentre, randomized, single-blind, four-arm controlled clinical trial designed to evaluate the safety and efficacy of different surgical strategies for patients with small-volume BPH. Eligible male participants aged 40 to 80 years with a prostate volume of less than 30 mL and clinically significant lower urinary tract symptoms or impaired voiding function will be enrolled. A total of 932 participants will be randomly assigned in a 1:1:1:1 ratio to one of four treatment groups: thulium laser enucleation of the prostate combined with bladder neck incision, thulium laser enucleation of the prostate alone, transurethral resection of the prostate (TURP), or transurethral incision of the prostate (TUIP).

The primary objective of the study is to compare the incidence of bladder neck contracture at 6 months after surgery among the treatment groups. Secondary outcomes include safety outcomes and changes in International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), Visual Analogue Scale (VAS) score, and IPSS response rate at 3 and 6 months after surgery. Exploratory outcomes include changes in post-void residual urine volume and sexual function scores, including the International Index of Erectile Function-5 (IIEF-5) and the Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD). Additional exploratory long-term outcomes will be assessed at 12 months after surgery, including delayed bladder neck contracture, maintenance of urinary function, late adverse events, and the need for reintervention.

The study is designed to provide high-quality evidence on the comparative safety and effectiveness of these four surgical approaches in men with small-volume BPH and to help define an optimal surgical strategy for this specific patient population.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

932

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Studiesteder

    • Beijing Municipality
      • Beijing, Beijing Municipality, Kina, 100039
        • Chinese PLA General Hospital
        • Kontakt:

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ingen

Beskrivelse

Inclusion Criteria:

  • Male patients aged 40-80 years.
  • Diagnosis of benign prostatic hyperplasia (BPH) and scheduled to undergo surgical treatment.
  • International Prostate Symptom Score (IPSS) of at least 12, maximum urinary flow rate of no more than 15 mL/s, with a voided volume greater than 150 mL.
  • Prostate volume of less than 30 mL measured by transrectal ultrasound (TRUS), calculated as length × width × height × 0.52.
  • Ability, as assessed by the investigator, to understand the study requirements and complete the scheduled treatment, follow-up visits, and study-related assessments.

Exclusion Criteria:

  • Inability or refusal to provide written informed consent, or inability to comply with the required follow-up schedule.
  • Prostate-specific antigen (PSA) level of 10 ng/mL or higher, unless prostate cancer has been excluded by biopsy.
  • Confirmed or suspected prostate or bladder malignancy.
  • Pre-existing bladder neck contracture or urethral stricture before surgery.
  • Known coagulation disorder or abnormal coagulation function.
  • Neurogenic bladder or detrusor underactivity that may affect bladder or urethral sphincter function.
  • Benign prostatic hyperplasia (BPH) complicated by acute urinary tract infection, acute prostatitis, or bacterial prostatitis.
  • History of prostate surgery, urethral stricture, or neurogenic bladder.
  • History of prostate cancer or pelvic radiotherapy.
  • Severe cardiovascular disease, pulmonary disease, or other systemic disease that, in the investigator's judgment, would make the patient unable to tolerate surgery.
  • Participation in another clinical trial related to benign prostatic hyperplasia (BPH) within 3 months before enrolment.
  • Any other condition that, in the investigator's opinion, makes the patient unsuitable for participation in this study.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Dobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: ThuLEP Combined With Bladder Neck Incision
Participants assigned to this arm will undergo thulium laser enucleation of the prostate combined with bladder neck incision. Hyperplastic prostatic tissue will be enucleated along the surgical capsule plane using a thulium fibre laser system. After enucleation and haemostasis, the bladder neck will be assessed intraoperatively, and bladder neck incision will be performed according to protocol-defined anatomical and obstructive findings when considered safe by the operating surgeon.
Participants will undergo transurethral thulium laser enucleation of the prostate combined with bladder neck incision. Hyperplastic prostatic tissue will be enucleated along the surgical capsule plane using a thulium fibre laser system. After enucleation and haemostasis, the bladder neck will be assessed intraoperatively, and bladder neck incision will be performed according to protocol-defined anatomical and obstructive findings when considered safe by the operating surgeon.
Aktiv komparator: ThuLEP Alone
Participants assigned to this arm will undergo thulium laser enucleation of the prostate alone. The procedure will be performed transurethrally, and hyperplastic prostatic tissue will be enucleated along the surgical capsule plane using a thulium fibre laser system, followed by haemostasis of the surgical wound.
Participants will undergo transurethral thulium laser enucleation of the prostate alone. Hyperplastic prostatic tissue will be enucleated along the surgical capsule plane using a thulium fibre laser system, followed by haemostasis of the surgical wound. No bladder neck incision will be performed as part of the assigned intervention.
Andre navne:
  • ThuLEP
Aktiv komparator: Transurethral Resection of the Prostate
Participants assigned to this arm will undergo transurethral resection of the prostate using a conventional resectoscope. Obstructive hyperplastic prostatic tissue will be resected transurethrally according to standard TURP principles to relieve obstruction while avoiding excessive resection and injury to adjacent structures.
Participants will undergo transurethral resection of the prostate using a conventional resectoscope. Obstructive hyperplastic prostatic tissue will be resected transurethrally according to standard TURP principles to relieve obstruction while avoiding excessive resection and injury to adjacent structures.
Andre navne:
  • TURP
Aktiv komparator: Transurethral Incision of the Prostate (TUIP)
Participants assigned to this arm will undergo transurethral incision of the prostate (TUIP) using standard endoscopic equipment. After endoscopic inspection of the urethra, prostatic urethra, bladder neck, and bladder, one or two longitudinal incisions will be made at the bladder neck and prostatic urethra according to prostate morphology and the degree of obstruction. The procedure aims to relieve bladder outlet obstruction without substantial prostatic tissue resection. The incision site and extent will be individualized based on intraoperative anatomy, with careful avoidance of injury to the ureteric orifices, urethral sphincter, and adjacent structures. Haemostasis will be performed when necessary.
Participants assigned to this intervention will undergo transurethral incision of the prostate using standard endoscopic equipment. One or two longitudinal incisions will be made at the bladder neck and prostatic urethra according to prostate morphology and the degree of obstruction. The procedure aims to relieve bladder outlet obstruction without substantial prostatic tissue resection. The incision site and extent will be individualized according to intraoperative anatomy, with careful avoidance of injury to the ureteric orifices, urethral sphincter, and adjacent structures. Haemostasis will be performed when necessary.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Incidence of Bladder Neck Contracture
Tidsramme: 6 months after surgery (180 ± 7 days)
Bladder neck contracture will be assessed based on postoperative symptoms, changes in urinary flow, cystoscopic findings, and investigator judgment.
6 months after surgery (180 ± 7 days)

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Incidence of Postoperative Retrograde Ejaculation
Tidsramme: Up to 6 months after surgery
Incidence of postoperative retrograde ejaculation during follow-up.
Up to 6 months after surgery
Incidence of Device-Related New-Onset Severe Urinary Retention
Tidsramme: Up to 6 months after surgery
Incidence of device-related new-onset severe urinary retention. Severe urinary retention is defined as urinary retention lasting more than 14 days after postoperative healing.
Up to 6 months after surgery
Incidence of Device-Related New-Onset Stress Urinary Incontinence
Tidsramme: Up to 6 months after surgery
Incidence of device-related new-onset stress urinary incontinence during follow-up.
Up to 6 months after surgery
Incidence of Device-Related Bleeding Events Requiring Blood Transfusion
Tidsramme: Up to 6 months after surgery
Incidence of device-related bleeding events requiring blood transfusion during follow-up.
Up to 6 months after surgery
Incidence of Device-Related Urethral or Prostatic Capsule Rupture Requiring Surgical Intervention
Tidsramme: Up to 6 months after surgery
Incidence of device-related urethral or prostatic capsule rupture requiring surgical intervention during follow-up.
Up to 6 months after surgery
IPSS Response Rate
Tidsramme: 3 months and 6 months after surgery
Proportion of participants achieving improvement in IPSS from baseline of at least 30%, 40%, or 50%.
3 months and 6 months after surgery
Change From Baseline in Maximum Urinary Flow Rate (Qmax)
Tidsramme: 3 months and 6 months after surgery
Change from baseline in maximum urinary flow rate (Qmax).
3 months and 6 months after surgery
Change From Baseline in International Prostate Symptom Score (IPSS)
Tidsramme: 3 months and 6 months after surgery
Change from baseline in International Prostate Symptom Score (IPSS). The International Prostate Symptom Score is a 7-item questionnaire used to assess the severity of lower urinary tract symptoms. The total score ranges from 0 to 35, with higher scores indicating more severe symptoms. A greater decrease from baseline indicates greater improvement.
3 months and 6 months after surgery
Change From Baseline in Visual Analogue Scale (VAS) Score
Tidsramme: 3 months and 6 months after surgery
Change from baseline in Visual Analogue Scale (VAS) score. The Visual Analogue Scale is used to assess postoperative pain. The score ranges from 0 to 10, with 0 indicating no pain and 10 indicating the worst imaginable pain. Higher scores indicate more severe pain, and a greater decrease from baseline indicates greater improvement
3 months and 6 months after surgery

Andre resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Change From Baseline in Post-Void Residual Urine Volume (PVR)
Tidsramme: 1 month, 3 months, and 6 months after surgery
Change from baseline in post-void residual urine volume (PVR).
1 month, 3 months, and 6 months after surgery
Change From Baseline in International Index of Erectile Function-5 (IIEF-5)
Tidsramme: 1 month, 3 months, and 6 months after surgery
Change from baseline in International Index of Erectile Function-5 (IIEF-5) score. The International Index of Erectile Function-5 is a 5-item questionnaire used to assess erectile function. The total score ranges from 5 to 25, with higher scores indicating better erectile function. A greater increase from baseline indicates greater improvement.
1 month, 3 months, and 6 months after surgery
Change From Baseline in Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD)
Tidsramme: 1 month, 3 months, and 6 months after surgery
Change from baseline in Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD) score. The Male Sexual Health Questionnaire-Ejaculatory Dysfunction is used to assess ejaculatory function. The ejaculatory function domain score ranges from 0 to 15, with higher scores indicating better ejaculatory function. A greater increase from baseline indicates greater improvement
1 month, 3 months, and 6 months after surgery
Exploratory 12-month follow-up outcomes
Tidsramme: 12 months after surgery
Exploratory long-term follow-up outcomes will be assessed at 12 months after surgery, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), International Index of Erectile Function-5 (IIEF-5), Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD), reoperation or retreatment, and procedure-related adverse events. For score-based outcomes, the corresponding scale ranges and score directions are as follows: the International Prostate Symptom Score ranges from 0 to 35, with higher scores indicating more severe urinary symptoms; the quality of life score ranges from 0 to 6, with higher scores indicating worse quality of life related to urinary symptoms; the International Index of Erectile Function-5 score ranges from 5 to 25, with higher scores indicating better erectile function; and the Male Sexual Health Questionnaire-Ejaculatory Dysfunction ejaculatory function domain sc
12 months after surgery

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Sponsor

Publikationer og nyttige links

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Generelle publikationer

Datoer for undersøgelser

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Studer store datoer

Studiestart (Anslået)

1. juli 2026

Primær færdiggørelse (Anslået)

1. december 2028

Studieafslutning (Anslået)

1. december 2028

Datoer for studieregistrering

Først indsendt

29. april 2026

Først indsendt, der opfyldte QC-kriterier

29. april 2026

Først opslået (Faktiske)

6. maj 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

21. juli 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

18. juli 2026

Sidst verificeret

1. juli 2026

Mere information

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Plan for individuelle deltagerdata (IPD)

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IPD-planbeskrivelse

No plan to share individual participant data at this time.

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