BERKELEY, CA (UroToday.com) - Over the last two decades, there have been many changes in the treatment of benign prostatic hypertrophy (BPH). Not only has there been the introduction of medications to treat lower urinary tract symptoms (LUTS), but there has also been the development of several different surgical modalities to address symptoms that do not respond to medical therapy. With the desire to improve upon the gold-standard -- transurethral resection of the prostate (TURP) -- laser surgery (coagulation, vaporization, or enucleation) is one example of a newer technology that developed in an effort to improve efficiency, safety, and decrease morbidity.
Using the New York Statewide Planning and Cooperation System (SPARCS) data, we were able to capture and analyze one of the largest population cohorts reported to date with over 90 000 patients. Our cohort reflects patients from all socioeconomic levels, includes both public and private hospitals, and is representative of real world care.
We were able to analyze this data and identify trends in BPH surgery. TURP remains the most common procedure, however, over the past 10 years, its use is declining. Laser-based surgeries have increased in usage over this same period of time. Our study also confirmed what other prior studies have found -- that laser and TURP are equivalent from a safety perspective.
So who are using laser therapies? High volume hospitals, defined as having greater than 200 BPH cases per year, were the places that adopted laser technology for the treatment of BPH. Perhaps the reason why we see this trend is because higher volume hospitals possess more resources, more access to training with lasers, and therefore are more likely to adopt new technologies.
Which patients are being treated with laser therapies? Interestingly, older patients and patients with more comorbid conditions were less likely to be treated. This finding in our study most likely reflects the beginning of laser therapy where surgeons needed to gain more expertise with the technology. We believe that if we examined a more contemporary cohort we will find laser utilized in these at-risk populations. Additionally, we found that Medicaid patients, although distributed evenly throughout the state and at different types of hospitals with different volumes, were least likely to be treated with laser surgery. Similar to prior studies, we found that disadvantaged socioeconomic patient groups were less likely to get newer technologies.
As with all new technologies, our collective goal as physicians is to improve upon existing standards of care and advance our specialty. In examining the trends in BPH surgery, it is clear that laser surgery has become an accepted, safe modality we can offer our patients. As our experience grows over time, we hope to have more experience and collect more long-term data to comment on the durability of laser technology.
Written by:
By Vannita Simma-Chiang and Bilal Chughtai as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Weill Medical College of Cornell University, New York, NY USA