Does Surgical Modality Affect Outcomes in BPH Treatment?

Outcomes associated with operative treatment for benign prostatic hyperplasia (BPH) could vary depending on the surgical modality used, a retrospective study found. The results were presented at the American Urological Association 2019 Annual Meeting.

According to the researchers, short- and intermediate-term data exist on outcomes associated with different BPH surgical techniques. However, long-term, real-world data are necessary to determine which surgical interventions have the greatest odds of reoperation.

The study included data from a single health system database on patients undergoing their first surgery for BPH between 2001 and 2006. Surgeries included transurethral resection of the prostate (TURP), laser vaporization of the prostate (LVP), and simple prostatectomy (SP). The primary outcome was subsequent endoscopic operation.

The final analysis included 4,985 patients, of whom 51.1% (n = 2,549) underwent LVP, 46.2% (n = 2,304) underwent TURP, and 2.7% (n = 132) underwent SP. During a median follow-up of 26.5 months, 8.4% of patients (n = 419) required reoperation, which occurred a median 19.5 months after the index surgery. Subsequent endoscopic operation rates varied significantly among the three surgery groups: LVP patients had the highest reoperation rate (10.5%, n = 268/2,549), followed by TURP patients (6.4%, n = 148/2,304) and SP patients (2.3%, n = 3/132) (P < 0.0001). The researchers used Cox proportional hazards regression analysis and adjusted for baseline demographic and clinical characteristics and found an independent correlation between index surgery modality and subsequent endoscopic surgery (P = 0.007). When using LVP as a reference group, TURP and SP patients had a significantly lower hazard ratio (HR) for reoperation (TURP: HR 0.78, 95% confidence interval [CI] 0.64-0.95; SP HR: 0.28, 95% CI 0.09-0.87).

The study authors concluded that the difference in reoperation rates among different BPH surgical interventions could have implications for long-term outcomes, as subsequent surgeries increase patient morbidity as well as healthcare resource utilization.

 

Khanna A, Sabharwal N, Fareed K, et al. Long-term Reoperation Rates Following Surgery for BPH: Variation Based on Surgical Modality