An increasing number of novel surgical treatments (NSTs) for benign prostatic hyperplasia (BPH) have been proposed over time to achieve similar functional outcomes, but better perioperative and sexual outcomes than traditional procedures.
To assess the trends in the utilization and costs of BPH surgical procedures over the past decade, and to analyze the need for surgical retreatment after each procedure.
A retrospective observational population-based analysis was conducted using the PearlDiver Mariner (PearlDiver Technologies, Colorado Springs, CO, USA) database, including all-payer nationally available claims records collected from 2011 to 2022.
The number and type of BPH surgical procedures per year, costs associated with each BPH surgical treatment, incidence of BPH surgical retreatment rate, and time to BPH surgical retreatment were assessed. Negative binomial regression and Cochran-Armitage test were used for the temporal trend analysis. A multivariable logistic regression analysis evaluated the predictors of BPH surgical retreatment.
In the study period, 274 808 patients received surgical treatment for BPH. The most common procedure was transurethral resection of the prostate (TURP; 71.7%). The overall utilization of BPH surgical treatment increased over the study period. Traditional surgery remained most performed for the entire period (87.8%), but a statistically significantly rising trend of NSTs was recorded. The mean reimbursements paid per procedure was 1.43 times higher (p < 0.001) for NSTs than for traditional procedures. The surgical retreatment rate was 9.4%. The mean time to surgical retreatment was 25.3 mo, with 85.5% of cases re-treated within 5 yr. At the multivariable analysis, transurethral incision of the prostate, photoselective vaporization of the prostate, prostatic urethral lift, convective water vapor energy, and prostatic artery embolization had a significantly greater likelihood of surgical retreatment than TURP. Holmium/thulium laser enucleation of the prostate (HoLEP/ThuLEP), open simple prostatectomy (SP), and laparoscopic/robot-assisted SP were associated with a lower probability of resurgery than TURP, but a similar probability between these procedures. Retrospective design and a lack of relevant clinical data were the main limitations.
Over the past decade, there has been a progressive increase in the adoption of NSTs. The rate of surgical retreatment appears <10%, with patients undergoing SP and HoLEP/ThuLEP experiencing a statistically significantly lower probability of surgical retreatment.
We investigated the trends, costs, and surgical retreatments of benign prostatic hyperplasia surgery. Transurethral resection of the prostate remains the most common procedure. Novel surgical treatments are associated with an upward trend, despite appearing more expensive overall. Retreatment is necessary in <10% of patients and generally within 5 yr.
European urology focus. 2024 Apr 25 [Epub ahead of print]
Francesco Ditonno, Celeste Manfredi, Leslie Claire Licari, Eugenio Bologna, Antonio Franco, Savio D Pandolfo, Marco De Sio, Cosimo De Nunzio, Cristian Fiori, Edward E Cherullo, Ephrem O Olweny, Alessandro Antonelli, Riccardo Autorino
Department of Urology, Rush University, Chicago, IL, USA; Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy., Department of Urology, Rush University, Chicago, IL, USA; Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy., Department of Urology, Rush University, Chicago, IL, USA; Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy., Department of Urology, Rush University, Chicago, IL, USA; Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy., Department of Neurosciences, Reproductive Sciences and Odontostomatology, "Federico II" University, Naples, Italy., Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy., Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy., School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy., Department of Urology, Rush University, Chicago, IL, USA., Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy., Department of Urology, Rush University, Chicago, IL, USA. Electronic address: .