No large-scale comparison of the four most established surgical approaches for LUTS due to benign prostate obstruction in terms of long-term efficacy is available. We compared photoselective vaporisation, laser enucleation and open simple prostatectomy to transurethral resection with regard to 5-year surgical re-intervention rates.
43.041 male patients with LUTS who underwent transurethral resection (n=34,526), photoselective vaporisation (n=3,050), laser enucleation (n=1,814) or open simple prostatectomy (n=3,651) between 2011 and 2013 were identified in pseudonymised claims and core data of the German local health care funds (AOK) and followed for 5 years. Surgical re-interventions for LUTS, urethral stricture or bladder neck contracture were evaluated. Surgical approach was related to re-intervention risk using the Kaplan-Meier method and Cox proportional-hazards models.
,050 first re-interventions occurred within 5 years of primary surgery (Kaplan-Meier survival without re-intervention: 87.5%, 95%-CI: 87.2%-87.8%). Photoselective vaporisation carried an increased hazard of re-intervention (HR 1.31, 95%-CI: 1.17-1.46, p <0.001) relative to transurethral resection, open simple prostatectomy carried a lower hazard (HR 0.43, 95%-CI: 0.37-0.50, p <0.001) and LEP did not differ significantly (HR 0.84, 95%-CI: 0.66-1.08, p=0.2). This pattern was more pronounced regarding re-intervention for LUTS recurrence (photoselective vaporisation: HR 1.52, 95%-CI: 1.35-1.72, p <0.001; LEP: HR 0.84, 95%-CI: 0.63-1.14, p=0.3; open simply prostatectomy: HR 0.38, 95%-CI: 0.31-0.46, p <0.001; relative to transurethral resection).
5-year re-intervention rates of transurethral resection and laser enucleation did not differ significantly, while photoselective vaporisation had a substantially higher rate. Open simple prostatectomy remains superior to transurethral resection with respect to long-term efficacy.
The Journal of urology. 2020 Oct 26 [Epub ahead of print]
Christian Gilfrich, Matthias May, Claus Fahlenbrach, Christian Günster, Elke Jeschke, Gralf Popken, Jens-Uwe Stolzenburg, Lothar Weißbach, Christoph von Zastrow, Hanna Leicht
Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany., Federal Association of the Local Health Care Funds (AOK), Berlin, Germany., Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany., Department of Urology, Ernst von Bergmann Hospital, Potsdam, Germany., Department of Urology, University of Leipzig, Leipzig, Germany., gfm (Gesundheitsforschung für Männer), Berlin, Germany., Medical Review Board of the Social Health Insurance Funds, Hannover, Germany.