Procedure For Benign Prostatic Hyperplasia Research Articles

The Safety and Feasibility of Aquablation in Patients with Previous Surgery for Benign Prostatic Hyperplasia.

Objective: Aquablation for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) has been adopted to treat a wide range of prostate anatomies including glands up to 150 cc. Patients with recurrence of LUTS after previous BPH procedure often present with variant anatomy, and a paucity of literature exists on the optimal treatment modality for these patients. Herein, we evaluate the safety and feasibility of aquablation in patients with previous BPH surgical history. Patients and Methods: A prospectively managed single institution database of aquablation patients with BPH/LUTS was queried from August 2020 to December 2022 for patients who failed previous BPH procedures. Patients were divided into two groups: those with and without previous BPH procedure. Primary outcomes were intraoperative and 90-day complications. Secondary outcomes included operative time (OT), number of Aquabeam passes, estimated blood loss, hospital length of stay, and catheter duration. Outcomes were assessed using chi-squared, Wilcoxon rank sum tests, and logistic regression. Results: A total of 200 patients with BPH/LUTS were treated with aquablation. We identified 26 patients with a history of previous BPH procedures. Patients who underwent previous BPH procedures had smaller prostate volumes (60 cc) compared with treatment-naïve (88 cc) patients, p = 0.016. There was no difference in perioperative and 90-day complications (29% for treatment-naïve vs 17% in the retreatment group, p = 0.32). Most secondary outcomes were the same including OT, but the retreatment group had fewer Aquabeam passes (2 [1-2] vs 2 [2-2] treatment-naïve, p = 0.037) and more additional procedures at follow-up (30% vs 8.3% treatment-naïve, p = 0.005). Conclusion: Patients with previous BPH interventions remain excellent candidates for aquablation, with similar perioperative and 90-day postoperative outcomes compared with intervention-naïve patients. Aquablation demonstrates efficient tissue ablation without the risk of increased injury or significant blood loss after prior failed BPH procedures.

Urinary Retention After GreenLight Laser Photoselective Vaporization of the Prostate (GLL.PVP) Surgery for Benign Prostatic Hyperplasia (BPH): A 3-6 Month Retrospective Follow-Up Study.

Objective Our study was designed to evaluate the postoperative urinary retention (UR) and success rate of the GreenLight Laser (Boston Scientific, Marlborough, MA, USA) photoselective vaporization of the prostate (GLL.PVP) procedure for Benign Prostatic Hyperplasia (BPH) patients, both with and without high-risk factors. Methodology We conducted a retrospective follow-up study of postoperative patients who underwent GLL.PVP for BPH. We collected data from clinical health records, including notes from the lower urinary tract symptoms (LUTS) clinic, trial without catheter (TWOC) clinic, and emergency department presentations with UR. The analysis examined several parameters, including the patient's age, high-risk factors, prostate volume, and both preoperative and postoperative objective voiding parameters. These voiding parameters included post-void residual (PVR) and maximum flow rate (Qmax). Additionally, the analysis looked into whether the patient had a catheter or experienced urinary retention prior to the surgery. Results A total of 50 GreenLight Laser PVP surgeries were performed over a 14-month period from May 2023 to July 2024 at West Middlesex University Hospital in London. Most of the patients were between the ages of 60 and 80. Prior to the surgery, data indicated that 17 patients (34%) were using long-term catheters, whereas 33 patients (66%) were not. Additionally, 25 patients (50%) were identified as having high-risk factors, which included being on anticoagulation therapy, a history of urinary retention, and a prostate volume exceeding 100 cc.Notably, the patient without h/o urinary retention had an average preoperative PVR of 150 mL and an averageQmaxof 7 mL/second In our 3-6 month retrospective postoperative follow-up study, we found that eight cases (16%) developed urinary retention, while 42 cases (84%) did not, with an average PVR volume of 105 mL and an average Qmax of 13.5 mL/second. In patients with preoperative urinary retention, 13 cases (76%) did not develop UR postoperatively whereas four cases (24%) developed. Conclusion Our study conclusively found that 42 cases (84%) of patients did not experience urinary retention (UR) in the follow-up after undergoing the GLL PVP operation, irrespective of any history of urinary retention or other high-risk factors. This unequivocally demonstrates the operation's efficacy. Furthermore, our findings revealed that three-quarters of patients with a preoperative history of urinary retention also did not develop UR post-surgery. The GLL.PVP procedure is safe and effective, leading to rapid improvements in voiding parameters.

Analyzing Antibiotic Usage Trends in Genitourinary Infections and Procedures: Insights From the TriNetX Database

ObjectiveTo analyze antibiotic prescribing trends, particularly the decline in fluoroquinolone use for various GUI and procedures, and the growing preference for alternative treatments. MethodsThe TriNetX database was queried for antibiotic utilization rates from 2016 to 2022. We analyzed cases of cystitis, pyelonephritis, prostatitis, and other GUIs as well as periprocedure utilization for benign prostatic hyperplasia (BPH), urethral stricture disease, pelvic organ prolapse/stress urinary incontinence (POP/SUI), and overactive bladder/interstitial cystitis (OAB/IC). We determined the top four to six antibiotics prescribed within five days of diagnosis or procedure. Statistical analysis included linear regression modeling. ResultsFrom 2016-2022, fluoroquinolone use decreased in cystitis (p<0.001), pyelonephritis (p < 0.001), and prostatitis (p < 0.01). These infections were increasingly treated with beta-lactams (p<0.0001, p<0.01, p<0.01, respectively). Additionally, we found a decrease in fluoroquinolone utilization in procedures for BPH (p<0.001), urethral stricture (p<0.01), POP/SUI (p<0.001), and OAB/IC (p < 0.001). All cohorts except for OAB/IC showed a significant increase in beta-lactam use (p<0.001, p<0.01, p<0.01, respectively). ConclusionsWe noted a significant decline in fluoroquinolone use for GUI and procedures, accompanied by increased beta-lactam use, reflecting changes in prescribing practices. Judicious use is essential to promote antimicrobial stewardship and mitigate severe adverse effects.

Transformations in Benign Prostatic Hyperplasia Surgical Practices: A Longitudinal Study of Trends and Predictions

Introduction: The workload for benign prostatic hyperplasia (BPH) surgery is expected to rise with an increase in life expectancy and a growing population. Surgical modalities for BPH have evolved, shifting toward minimally invasive transurethral procedures. This study aimed to investigate the trends in BPH surgical procedures across medical centers in Israel. Methods: Data from seven academic medical centers in Israel from 2010 to 2022 were analyzed. Procedures included open prostatectomy, transurethral prostatectomy (TURP), holmium laser enucleation of the prostate (HoLEP), and photovaporization of the prostate (PVP). Statistical analyses were employed, including t tests, ANOVA, and ARIMA models. Results: Over 12 years, 13,478 BPH procedures were performed. TURP was the most common (72%), followed by open surgery (12%), HoLEP (12%), and PVP (3%). Annual procedures increased by approximately 5% each year, with a cumulative surge of 63% cases by 2022. The average patient’s age remained stable. TURP and HoLEP showed continual growth, while open surgery declined. HoLEP exhibited a shorter length of hospital stay compared to other modalities. Predictive models suggest open prostatectomy will cease within 2 years, while TURP and HoLEP will continue to rise. Conclusion: This study highlights a significant increase in BPH surgical procedures over time, with a notable preference for TURP and HoLEP. The findings emphasize the importance of size-independent techniques like HoLEP for optimal healthcare management in the future.

Prostate Risk and Monitoring During Testosterone Replacement Therapy.

Men with hypogonadism have reduced risk of prostate cancer mortality; whether testosterone treatment increases the risk of prostate safety events in men with hypogonadism remains controversial. Several studies including 4 larger randomized trials-the Testosterone Trials, TEstosterone and Atherosclerosis Progression in Aging Men (TEAAM) trial, Testosterone for Diabetes Mellitus trial, and Testosterone Replacement therapy for Assessment of long-term Vascular Events and efficacy ResponSE in hypogonadal men (TRAVERSE) trial-treated men with testosterone or placebo for 1 year or longer and reported prospectively ascertained prostate safety data. The TRAVERSE Trial, because of its large size, longer duration, and adjudication of prostate events, has provided comprehensive data on the risk of adverse prostate events during testosterone replacement therapy (TRT). Among men with hypogonadism, carefully screened to exclude those at high risk of prostate cancer, the incidences of high-grade or any prostate cancer, acute urinary retention, surgical procedure for benign prostatic hyperplasia, prostate biopsy, or new pharmacologic therapy for lower urinary tract symptoms were low and did not differ between the testosterone and placebo groups. Testosterone did not worsen lower urinary tract symptoms. TRT was associated with a greater increase in prostate-specific antigen than placebo in the first year of treatment. Testosterone treatment of men with hypogonadism, screened to exclude those at high risk of prostate cancer, is associated with low risk of adverse prostate events. Baseline evaluation of prostate cancer risk and a standardized monitoring plan can minimize the risk of unnecessary prostate biopsy while enabling the detection of high-grade prostate cancers in men receiving TRT.

Prostate Artery Embolization as Minimally Invasive Treatment for Benign Prostatic Hyperplasia: An Updated Systematic Review.

Background/Objectives: Benign prostatic hyperplasia (BPH) has a significant impact on the quality of life of symptomatic patients. In patients manifesting lower urinary tract symptoms (LUTS), prostatic arterial embolization (PAE) has become a topic of interest in recent years. The purpose of this systematic review is to analyze and review techniques and clinical outcomes of patients who underwent endovascular treatment of BPH, with a special focus on the comparison of surgical and endovascular procedures. Methods: Through the major scientific databases, 1225 articles were selected from the initial research utilizing specific keywords and medical subject headings. Based on the inclusion and exclusion criteria established for selecting relevant studies for our purposes, the systematic analysis of the literature was conducted on a total of seven articles. Results: We collected data on 718 male patients (408 patients underwent PAE and 310 received TURP). The technical success rate varied from 86% to 100% for TAE and was 100% for TURP. During a 12-month follow-up period, both PAE and TURP were comparable on the reduction in IPSS and QoL questionnaire, while TURP showed significant improvements in Qmax and in the reduction in prostate volume. Length and cost of hospitalization were lower for PAE. Complication and adverse events rates were higher in the TURP group rather than in the PAE group (60.6% vs. 35.5%). Conclusions: Prostatic artery embolization represents an emerging minimally invasive procedure for BPH. According to previously released clinical studies, quality-of-life and urological symptom scores of the PAE group were comparable to those of the TURP group. Our research strengthens the evidence supporting the effectiveness and safety of PAE as a therapy for LUTS related to BPH.

Systematic review and network meta-analysis of re-intervention rates of new surgical interventions for benign prostatic hyperplasia.

To assess the re-intervention rates of new surgical benign prostatic hyperplasia (BPH) interventions, as the clinical durability of new surgical interventions for BPH is not widely known. A critical review of new surgical BPH therapies namely 'UroLift®', 'Aquablation', 'Rezum', 'prostatic artery embolisation (PAE)' and 'temporary implantable nitinol device (iTIND)' was performed on PubMed, the Cochrane Library, and Embase databases between May 2010 and December 2022 according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement. All relevant articles were reviewed, and the risk of bias was evaluated using the Cochrane risk assessment tool and Newcastle-Ottawa Scale. Of the 32 studies included, there were 10 randomised controlled trials and 22 prospective observational cohorts. A total of 2400 participants were studied with a median patient age of 66 years, a median prostate volume of 51.9 mL, and a median International Prostate Symptom Score of 22. The lowest re-intervention rate at 12 months was for Aquablation at 0.01%, followed by Rezum at 0.02%, iTIND at 0.03%, and PAE at 0.05%. Network meta-analysis (NMA) showed that the best-ranked treatment at 12 months was transurethral resection of the prostate (TURP), followed by Aquablation, iTIND, Rezum, and UroLift. Re-intervention rates with these new BPH interventions are comparable, although some interventions reported better outcomes than TURP in the shorter term. While this systematic review and NMA showed that the re-intervention rate with these new surgical BPH interventions appears to be comparable to TURP in the short term, further studies are required to directly compare these various BPH procedures.

(207) Ejaculatory Function After Benign Prostatic Hyperplasia (BPH) in Gay and Bisexual Men

Abstract Introduction Retrograde ejaculation (RE) is a common outcome of surgical treatments for benign prostatic hyperplasia (BPH). Previous qualitative work in the context of prostate cancer has shown that gay and bisexual men (GBM) experience greater bother from loss of ejaculatory function. Ideally, BPH treatment decision-making for GBM who prioritize ejaculatory function would take into consideration their specific needs and outcomes. However, there is no quantitative or prospective data on BPH outcomes in GBM men to inform their care. Objective Our objective was to analyze the characteristics of BPH patients in a urology clinic catered to the needs of GBM in order to fill the gaps in knowledge of BPH outcomes in GBM and improve care. Methods We performed a retrospective review of all GBM patients presenting to an LGBT specialized urology clinic between 9/1/2021 and 4/30/2023. Patients who underwent a procedure for BPH with at least one recorded AUA symptom score were included. Results 24 gay and bisexual BPH patients presenting to the clinic between 9/29/2021 and 4/25/2023 were included. Ages ranged from 32 to 82, with a mean age of 64.23 (SD = 11.43, n=24). The distribution of treatments offered was TURP (n=14), Rezum (n=4) and TUIP (n=1). Of the TURP procedures, 10 were ejaculatory sparing. Four patients received two forms of treatment. Of the 16 patients asked, 14 said ejaculatory sparing mattered to them (Mean age = 67.03, SD = 6.28) and 2 said it did not (Mean age = 77.63, SD = 10.57). The average pre-treatment AUA-Symptom Score for the patients was 20.85 (SD = 6.89, n=13) and average QoL was 4.00 (SD = 1.13, n=12). The average post-treatment AUA symptom score for patients was 8.50 (SD = 5.21, n=8), and average QoL was 1.38 (SD = 1.41, n=8). Conclusions A vast majority of the clinic’s GBM patients place importance on ejaculatory function. Younger GBM placed greater importance on ejaculatory function compared to older men. AUA symptom scores on average were on the low end of severe pre-treatment, with patients feeling mostly dissatisfied with urinary function. Post treatment AUA symptom scores varied but were centered around the low end of moderate, with patients feeling mostly pleased with urinary function. These initial findings from our clinic highlight the need for further prospective research on GBM patient values and outcomes surrounding ejaculatory function. Disclosure No.

National Trends in Surgical Management for Benign Prostatic Hyperplasia From 2013 to 2019 in the United States.

Benign prostatic hyperplasia (BPH) is a common urologic pathology for older men. The prevalence and effect on quality of life have prompted the development of new surgical procedures to manage BPH while attempting to minimize treatment side effects. The objective of this study is to utilize TriNetX, a third-party database, to investigate temporal trends in BPH procedures from 2013 to 2019 in the United States. Male patients aged 18 to 100 who were diagnosed with BPH from 2013 to 2019 were filtered from the TriNetX Diamond Network. Yearly cohorts undergoing a BPH-related procedure were searched using Current Procedural Terminology and International Classification of Diseases 10th Revision codes. Temporal and descriptive analytics were utilized to describe trends in treatment utilization. There were 302,646 BPH procedures recorded on the TriNetX Diamond Network. Transurethral resection of the prostate was the most commonly performed procedure, accounting for 47.2% of procedures in 2013 and 44.9% in 2019. Photoselective vaporization of the prostate remained a popular treatment but showed the greatest decrease in utilization over time (31.8% in 2013, 21.5% in 2019). Prostatic urethral lift (UroLift) was rapidly embraced as a treatment modality, as usage increased by 18.3% over a 6-year period (0.0% in 2014, up to 18.3% in 2019). Other procedures such as Rezūm (5.8%) and holmium laser enucleation of the prostate (5.1%) made up greater proportions of BPH procedures by 2019. Transurethral resection of the prostate was the most common procedure from 2013 to 2019. However, minimally invasive surgeries represent an increased percentage of BPH surgeries every year.

Incidence of Surgical Reintervention for Benign Prostatic Hyperplasia Following Prostatic Urethral Lift, Transurethral Resection of the Prostate, and Photoselective Vaporization of the Prostate: A TriNetX Analysis

BackgroundProstatic urethral lift, or UroLift, has gained popularity as a treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). Surgical reintervention rates are a reliable indicator for treatment durability. ObjectiveThe objective of this study was to utilize TriNetX, a third-party database, to investigate the incidence of surgical reintervention following UroLift, transurethral resection of the prostate (TURP), and photoselective vaporization of the prostate (PVP) procedures for BPH from 2015 to 2018. Design, setting, and participantsMale patients aged 18–100 yr diagnosed with BPH were identified in the TriNetX Diamond Network database between January 2015 and December 2018. Cohorts of individuals undergoing their first UroLift procedure were built using Current Procedural Terminology and International Classification of Diseases 10th Revision codes. TURP and PVP cohorts were built as comparison groups. The cohorts were then queried for subsequent BPH-related procedures. Outcome measurements and statistical analysisReprocedure rates were assessed and descriptive statistics were used. Results and limitationsThe mean age at first-time UroLift was 70.1 ± 9.4 yr (n = 14 343). Cumulative reprocedure rates collected after first-time UroLift included 1 yr after UroLift (5.1%, n = 14 343) and 4 yr after UroLift (16.1%, n = 710), with an average annual increase of +3.6% per year following 1 yr after the procedure. Comparatively, TURP (n = 22 071) and PVP (n = 14 110) had 4-yr reprocedure rates of 7.5% and 7.8%, respectively, during the same timeframe. Limitations include a lack of clinical data and loss of follow-up data outside the Diamond Network. ConclusionsThe reprocedure rate of UroLift at 4 yr is double the rate of TURP and PVP. In appropriately selected patients, UroLift might be a suitable option for those who desire symptomatic relief from BPH with minimal erectile and ejaculatory side effects. However, the risk of secondary surgical intervention should be considered when considering BPH treatments. Patient summaryWe compared the reintervention rates of prostatic urethral lift (PUL), transurethral resection of the prostate (TURP), and photoselective vaporization of the prostate (PVP) using the TriNetX database, and have found that the highest reintervention rates were for PUL of 16% at 4 yr of follow-up, compared with about 8% for those who had TURP and PVP. Interestingly, the most common reintervention was the same operation at 1 yr. This has important implications when counseling patients about the durability of these various outlet procedures for BPH.

Comparison of Minimally Invasive Procedures for Benign Prostatic Hyperplasia: A Cost-effectiveness Analysis.

Background Benign prostatic hyperplasia (BPH) is a disease that affects millions of U.S. men and is costly to treat. Purpose To compare the cost-effectiveness of four minimally invasive therapies (MITs) and medical management for the treatment of BPH. Materials and Methods A cost-effectiveness analysis from a payer's perspective with Markov modeling was performed, comparing prostatic artery embolization (PAE), prostatic urethral lift, aquablation, water vapor thermal therapy, and medical management for BPH spanning a time horizon of 5 years. The model incorporated the probability of procedural complications and recurrent symptoms necessitating retreatment, which were extracted from published studies with long-term follow-up. Costs were based on Medicare reimbursements using CPT codes for ambulatory surgery centers. Outcomes were measured using the quality-adjusted life year (QALY), incorporating both life quality and expectancy. Statistical analyses included a base case calculation (using the most probable value of each parameter) and probabilistic and deterministic sensitivity analyses. Results In the base case calculation, outcomes for the strategies were comparable, with a difference of 0.030 QALY (11 days of life in perfect health) between the most (PAE) and least (medical management) effective strategies. PAE was the most cost-effective strategy relative to medical management, with an incremental cost-effectiveness ratio of $64 842 per QALY. Probabilistic sensitivity analysis showed PAE was more cost-effective compared with prostatic urethral lift, aquablation, water vapor therapy, and medical management in pairwise comparisons. In sensitivity analysis of retreatment risk, PAE remained the most cost-effective strategy until its repeat treatment rates exceeded 2.30% per 6 months, at which point water vapor therapy became the optimal choice. PAE was the most cost-effective procedure when its procedural cost was lower than $4755. Aquablation and prostatic urethral lift became more cost-effective when their procedural costs were lower than $3015 and $1097, respectively. Conclusion This modeling-based study showed that PAE appears to be a cost-effective modality among medical management and MITs for patients with BPH, with comparable outcomes to prostatic urethral lift, water vapor therapy, and aquablation at a lower expected cost. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Gemmete in this issue.

Comparison of surgical procedures for benign prostatic hyperplasia of medium-volume prostates: evaluation of the causes of rehospitalization from the French National Hospital Database (PMSI-MCO).

In France, transurethral resection of the prostate (TURP) is still the most commonly used surgical treatment for medium sized benign prostatic hyperplasia (BPH), but the Holmium Laser Enucleation of the Prostate (HoLEP) and laser vaporization procedures are becoming more common. For these three surgical procedures, we evaluate the initial complications, the short term (3months) and the 4-12-month postoperative complications necessitating re-hospitalization. From the French national hospital data base (PMSI-MCO), all hospitalizations for BPH treatment in 2018 were extracted. We document the complications during the initial hospitalization and any subsequent rehospitalizations during the one-year postoperative period. In 2018, 67,220 patients were treated for BPH: 46,242 TURP, 13,509 HoLEP and 7469 laser vaporization. Age and anticoagulation medications were similar for men treated by the three procedures, but TURP patients were more often hypertensive. Infections and hemorrhagic complications were the most common complications at the initial hospitalization: 17%, 10%, 13% for infections and 15%, 8.1%, 11% for hemorrhagic complications respectively, and TURP performed worse than the other two procedures at the initial hospitalization. During the first three months and then the subsequent nine months, there were fewer complications than initially, with little difference between the three procedures, all differences being less than 1%. Laser vaporization techniques led to fewer complications. However, the PMSI-MCO only registers complications during hospitalizations. This study should be extended to non-hospitalized, more minor complications.

Risk Factors for Persistent Lower Urinary Tract Symptoms 1 Month Following Convective Water Vapor Thermal Therapy (CWVTT-Rezum)

To investigate the incidence and risk factors of persistent lower urinary tract symptoms (LUTS) 1 month and later following convective water vapor thermal therapy (CWVTT) in men with LUTS secondary to benign prostatic hyperplasia (BPH). Patients who underwent CWVTT from 11/2018-5/2021 at a single institution were eligible for inclusion and retrospectively identified. Pertinent patient, operative, and outcomes data were extracted. The primary outcome was clinically significant LUTS improvement at 4 weeks following CWVTT. Persistent LUTS was defined as failure to reach a minimally clinical important difference of 25% reduction on International Prostate Symptom Score at 4 weeks. One hundred nine patients qualified. Fifty percent of patients experienced persistent LUTS at 1 month. Eighty-two percent of men ultimately reached the minimally clinical important difference. For each additional month following CWVTT, the odds of achieving clinically significant LUTS improved by 9% (Odds ratio (OR)=0.91, P=.0033). Bladder outlet obstruction index and prior surgical BPH therapy were associated with persistent LUTS on multivariate logistic regression. Every 10-unit increase in Bladder outlet obstruction index noted at baseline was associated with a 15% increased likelihood of achieving minimally clinical important difference in LUTS at 4 weeks following CWVTT (OR=0.85, P=.01). Patients receiving prior surgical BPH therapy were 3.5 times more likely to experience persistent LUTS at 1 month (OR=3.47, P=.01). Fifty percent of men experienced persistent LUTS 1 month following CWVTT. However, LUTS improved with time and the majority of men ultimately achieved clinically significant LUTS improvement. A lower baseline Bladder outlet obstruction index and prior BPH procedures are risk factors for persistent LUTS following CWVTT.

Adoption and Outcomes of Holmium Laser Enucleation of the Prostate in the United States

To investigate the utilization of holmium laser enucleation of the prostate (HoLEP) using a large real-world cohort. We compare the safety, readmission, and retreatment rates of HoLEP to other widely used endoscopic surgical interventions for benign prostatic hyperplasia (BPH) including transurethral resection of the prostate (TURP), photoselective vaporization of the prostate, and prostatic urethral lift. Men who underwent endoscopic treatments for BPH from 2000 to 2019 were identified in the Premier Healthcare Database (n=218,793). We compared the relative proportion of each procedure performed and annual physician volume data to identify trends in adoption and utilization. Readmission and retreatment rates were determined at both 30- and 90-dayspostoperation. Multivariable logistic regression was used to assess the association between procedure type and outcomes. HoLEP accounted for 3.2% (n=6967) of all the BPH procedures performed between 2000 and 2019 and increased from 1.1% of the procedures in 2008 to 4% in 2019. Patients undergoing HoLEP had lower odds of 90-days readmission compared to TURP (Odds ratio (OR) 0.87, p=0.025). HoLEP had similar odds of retreatment compared to TURP at both 1-year (OR 0.96, p=0.7) and 2-years (OR 0.98, p=0.9), while patients undergoing photoselective vaporization of the prostate and prostatic urethral lift were more likely to retreat within 2-years (OR 1.20, P<0.001; OR 1.87, P<0.001). HoLEP is a safe therapy for BPH with lower readmission and comparable retreatment rates to the gold standard TURP. Despite this, the utilization of HoLEP has lagged behind other endoscopic procedures and remains low.

Australian surgical revision rate for benign prostatic obstruction.

To evaluate the rate of revision surgery following commonly performed procedures for benign prostatic hyperplasia (BPH) is hyperplasia of both glandular and stromal components of prostate especially in periurethral transitional gland, using real-world data from Medicare Australia. Prospection is a Healthcare Data Analytics firm that has negotiated access with the Medicare Benefits Schedule (MBS) to provide longitudinal data on the use of specific procedural item codes. We identified patients over the age of 40 years who had undergone primary transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP) or photoselective vaporization of the prostate (PVP) between 2005 and 2010 using MBS item numbers 37203, 37207 and 36854, respectively. Using longitudinal MBS data, primary outcomes included need for revision surgery at 5-years follow-up (2015). The release of these data was approved by Medicare Australia upon application. Data analysis was conducted using chi-squared tests and statistical significance was defined at P < 0.05. The distribution of primary surgical procedures performed between 2005 and 2010 was: TURP 5579 (90%), TUIP 345 (6%) and PVP 258 (4%). TURP was also the most prevalent procedure for treatment of lower urinary tract symptoms in men with BPH requiring revision surgery (75%). At 5-year follow-up the rate of revision surgery for TURP (573/5579), TUIP (47/345) and PVP (30/258) was 10.3%, 13.6% and 11.6%, respectively. The difference was not statistically significant (P= 0.12). There was no significant change (P = 0.59) observed over the years in number of men requiring revision surgery. This study indicates that TURP and PVP have a similar durability after 5 years of follow-up.

MP51-05 SAFETY AND TRENDS IN SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 Apr 2023MP51-05 SAFETY AND TRENDS IN SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA Dhaval Jivanji, Benjamin Shpeen, Michael West, Eitan Katlowitz, Michael Lee, Payam Hakimian, Jacob Khurgin, and Ariel Schulman Dhaval JivanjiDhaval Jivanji More articles by this author , Benjamin ShpeenBenjamin Shpeen More articles by this author , Michael WestMichael West More articles by this author , Eitan KatlowitzEitan Katlowitz More articles by this author , Michael LeeMichael Lee More articles by this author , Payam HakimianPayam Hakimian More articles by this author , Jacob KhurginJacob Khurgin More articles by this author , and Ariel SchulmanAriel Schulman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The armamentarium for surgical management of benign prostatic hyperplasia (BPH) continues to grow. However, the rates of adoption of multiple techniques over the gold standard have largely been unstudied. Therefore, this study aims to elucidate the most recent trends and safety profile of surgical management for BPH. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, patients who underwent a BPH procedure from 2016 to 2020 were included (CPT: 52601, 52630, 52648, 55821, 55831, 53854, 52649). Demographic characteristics and the use of each modality were analyzed. The safety profile was assessed by comparing complication rates to transurethral resection of prostate (TURP), which included transfusion rates, urinary tract infection, sepsis, readmission, and death. Chi-square analysis was utilized to determine any significant differences. RESULTS: Overall, 60,291 BPH procedures were performed in the time period studied with an annual average of 12,058. The median age of men undergoing any of the studied modalities ranged from 69-74 years old. White men comprised the largest proportion of the total cohort (63.4%, n=38,222) followed by Black men (6.4%, n=3,884). At least two-thirds of all procedures each year were TURP (Figure 1). A significant decline was seen in the use of photovaporization of prostate (PVP) (24.4% in 2016 vs. 21.0% in 2020, p<0.001). In 2020, 7.5% of all BPH procedures were HoLEP, which is a significant growth from 4.8% in 2016 (p<0.001). Rezum was introduced in 2019 and accounted for 1% of procedures in 2020. Every procedure studied had limited mortality risk (all <1.0%). Compared to TURP, open prostatectomy had the biggest difference in transfusion rates (12.2% vs. 1.5%, p<0.001) and readmissions (7.5% vs. 5.6%, p<0.001), while Rezum has the biggest difference in urinary tract infections (9.7% vs. 5.2%, p=0.006) and sepsis (2.7% vs. 1.0%, p=0.02). CONCLUSIONS: TURP remains the gold standard for BPH management; however, HoLEP continues to see increased adoption over time. Significant morbidity is seen with open prostatectomy. Infection and sepsis rates from Rezum procedures should be further studied as more patient data becomes available. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e694 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dhaval Jivanji More articles by this author Benjamin Shpeen More articles by this author Michael West More articles by this author Eitan Katlowitz More articles by this author Michael Lee More articles by this author Payam Hakimian More articles by this author Jacob Khurgin More articles by this author Ariel Schulman More articles by this author Expand All Advertisement PDF downloadLoading ...

PD41-01 TRENDS IN THE DIAGNOSTIC AND SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH) IN THE UNITED STATES: ANNUAL CHANGES IN THE SELECTION OF TREATMENT OPTIONS AND AVERAGE COSTS DIFFERENTIAL FOR DIAGNOSTIC/SURGICAL TECHNIQUE

You have accessJournal of UrologyCME1 Apr 2023PD41-01 TRENDS IN THE DIAGNOSTIC AND SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH) IN THE UNITED STATES: ANNUAL CHANGES IN THE SELECTION OF TREATMENT OPTIONS AND AVERAGE COSTS DIFFERENTIAL FOR DIAGNOSTIC/SURGICAL TECHNIQUE Jin-Kyu Oh, Francesco Del Giudice, Eugenio Bologna, Vincenzo Asero, Carlo Maria Scornajenghi, Ettore De Berardinis, Alessandro Sciarra, Satvir Basran, Shufeng Li, Federico Belladelli, and Benjamin I. Chung Jin-Kyu OhJin-Kyu Oh More articles by this author , Francesco Del GiudiceFrancesco Del Giudice More articles by this author , Eugenio BolognaEugenio Bologna More articles by this author , Vincenzo AseroVincenzo Asero More articles by this author , Carlo Maria ScornajenghiCarlo Maria Scornajenghi More articles by this author , Ettore De BerardinisEttore De Berardinis More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Satvir BasranSatvir Basran More articles by this author , Shufeng LiShufeng Li More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , and Benjamin I. ChungBenjamin I. Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transurethral resection of the prostate (TURP) is the gold standard treatment for benign prostatic hyperplasia (BPH). However, laser surgery techniques (e.g., photoselective vaporization of the prostate [PVP], holmium laser, thulium laser enucleation of the prostate [HoLEP or ThuLEP]), and minimally invasive treatment options (e.g., UroLift®) are increasingly replacing TURP. The aim of the study is to present the annual rates of BPH surgery and to analyze recent trends in the utilization of newer surgical modalities and any changes in medical costs related to these treatments over a 15-year period in the US. METHODS: Patient data was collected from the Optum Clinformatics® Data Mart Claims Database. Trends and distribution of surgical BPH techniques over the years of enrollment were analyzed across US regions. We then reviewed trends in adoption of diagnostic BPH methods including urodynamic studies, cystourethroscopy, transrectal ultrasound, prostatic biopsy, uroflowmetry, and the measurement of post-void residual urine volume (PVR). Finally, incidental diagnoses of prostate cancer (PCa) detected during BPH procedures were recorded over the years to depict the trends in PCa detection as well as median prostate specific antigen (PSA) values associated with BPH patients ultimately treated with a procedure. RESULTS: N=51,448 patients underwent BPH procedures from 2004 to 2017. There was a significant increase in the annual rate from 770 in 2004 to 6,571 in 2017. The mean patient age (±SD) increased from 67.6 years old (± 8.4) in 2004 to 73.4 years old (±8.4) in 2017. More than 60% of patients underwent cystourethroscopy and post-void residual urine check for workup prior to surgical management. TURP was the most common and PVP was the second most common BPH procedure. The total number of BPH diagnoses were 44,820 and the median cost for each procedure was $1459, $1875, $1419, and $3284 for TURP, PVP, HOLEP/ThULEP, Urolift, respectively. The median overall cost was $2471. With regard to the costs of treating BPH surgically, the diagnostic and treatment costs demonstrated annual increases while the detection rate of prostate cancer after BPH surgery gradually decreased from 19.87% in 2004 to 5.78% in 2017. CONCLUSIONS: We found recent trends in BPH management that demonstrates that alternative methods are starting to replace the traditional TURP technique, although TURP still remains the most common procedure. Future studies should assess whether these newer methods are both efficacious and cost effective over the long term. Of note, the cumulative incidence of PCa diagnosis was reduced over time, likely multifactorial in nature. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1058 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jin-Kyu Oh More articles by this author Francesco Del Giudice More articles by this author Eugenio Bologna More articles by this author Vincenzo Asero More articles by this author Carlo Maria Scornajenghi More articles by this author Ettore De Berardinis More articles by this author Alessandro Sciarra More articles by this author Satvir Basran More articles by this author Shufeng Li More articles by this author Federico Belladelli More articles by this author Benjamin I. Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

MP76-20 TRENDS IN SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA: DATA FROM THE AUA QUALITY (AQUA) REGISTRY

You have accessJournal of UrologyCME1 Apr 2023MP76-20 TRENDS IN SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA: DATA FROM THE AUA QUALITY (AQUA) REGISTRY Charles Jones, Benjamin Breyer, Rachel Mbassa, William Meeks, Raymond Fang, and Matthew Cooperberg Charles JonesCharles Jones More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Rachel MbassaRachel Mbassa More articles by this author , William MeeksWilliam Meeks More articles by this author , Raymond FangRaymond Fang More articles by this author , and Matthew CooperbergMatthew Cooperberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The list of surgical options for benign prostatic hyperplasia (BPH) has exploded in recent years, but little is known about the uptake of these new procedures in community urology practice. In this study we aimed to examine surgical BPH practices and trends across the country using the American Urological Association Quality Registry (AQUA). METHODS: The AQUA Registry was launched in 2014 to centralize quality reporting and improvement, primarily among community-based urology practices. Data regarding surgical BPH management from 2014-2021 were accessioned directly from electronic health records at 245 practices across the country. Procedures were grouped by CPT code. These included prostatic urethral lift (Urolift), transurethral incision of the prostate (TUIP), transurethral resection of the prostate (TURP), repeat TURP, laser coagulation of the prostate, laser vaporization of the prostate, holmium laser enucleation of the prostate (HoLEP), transurethral microwave therapy (TUMT), transurethral needle ablation (TUNA), transurethral destruction of the prostate by water vapor thermal therapy (Rezum), simple prostatectomy, and other genitourinary procedure. Patients were characterized by race and age. Practice location was also examined. RESULTS: The mean age of BPH diagnosis was 66.4 years old. 72% were White, 7% Black, 1% Asian, and 20% unknown. A total of 300,215 BPH procedures were recorded from 2014-2021. TURP had the greatest overall decline from a relative incidence of 40.1% of total BPH procedures in 2016 to 25.6% in 2021. TURP was used for 32% of White patients, 34% of Black patients, and 26% of Asian patients. Urolift use grew from 0.7% of cases in 2014 to 30.1% in 2021. HoLEP comprised approximately 1% of procedures throughout the time period studied. CONCLUSIONS: There has been a large shift in the procedures of choice for surgical management of BPH within community urology practices in the United States, with Urolift having a significant increase in total and relative proportions of procedures performed since its FDA approval in 2013. There has been a concurrent decrease in TURP, while HoLEP has stayed relatively consistently uncommon in community practice. Source of Funding: AQUA Registry is funded by the American Urological Association © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1100 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charles Jones More articles by this author Benjamin Breyer More articles by this author Rachel Mbassa More articles by this author William Meeks More articles by this author Raymond Fang More articles by this author Matthew Cooperberg More articles by this author Expand All Advertisement PDF downloadLoading ...

PD02-06 SERUM TESTOSTERONE AND DIHYDROTESTOSTERONE AND INCIDENCE AND PROGRESSION OF LOWER URINARY TRACT SYMPTOMS IN REDUCTION BY DUTASTERIDE OF PROSTATE CANCER EVENTS TRIAL

You have accessJournal of UrologyCME1 Apr 2023PD02-06 SERUM TESTOSTERONE AND DIHYDROTESTOSTERONE AND INCIDENCE AND PROGRESSION OF LOWER URINARY TRACT SYMPTOMS IN REDUCTION BY DUTASTERIDE OF PROSTATE CANCER EVENTS TRIAL James Daniels, James Mirocha, Daniel Moreira, Gerald Andriole, and Stephen Freedland James DanielsJames Daniels More articles by this author , James MirochaJames Mirocha More articles by this author , Daniel MoreiraDaniel Moreira More articles by this author , Gerald AndrioleGerald Andriole More articles by this author , and Stephen FreedlandStephen Freedland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003219.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) is common in older men, with many developing lower urinary tract symptoms (LUTS) that impair quality of life. Though the pathogenesis of BPH is unclear, it was previously believed that increasing androgen levels had a role, though not all data support this idea. We tested if elevated serum testosterone and elevated serum DHT are risk factors for LUTS incidence in asymptomatic men and for LUTS progression in symptomatic men. METHODS: A post-hoc analysis of REDUCE was carried out in 3009 asymptomatic men with baseline International Prostate Symptom Score (IPSS) <8 and in 2145 symptomatic men with baseline IPSS≥8 not taking α-blockers or 5α-reductase inhibitor medications. The Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial was a randomized trial of dutasteride for prostate cancer prevention in men with an elevated PSA and negative pre-study biopsy. IPSS was measured every 6 months over the 4-year study. We estimated multivariable adjusted hazard ratios (adj-HRs) and 95% confidence intervals (CIs) using Cox models to test the association between quintiles of serum testosterone and quintiles of serum dihydrotestosterone (DHT) at baseline and LUTS incidence and progression. Among asymptomatic men, incident LUTS was defined as the first report of medical treatment, surgery or sustained clinically significant LUTS (i.e., 2 reports of IPSS>14). Among symptomatic men, LUTS progression was defined as an IPSS increase of ≥4 points from baseline, any surgical procedure for BPH, or the start of a new BPH medication. RESULTS: In asymptomatic men, relative to the lowest quantile, all quintiles of serum testosterone and all quintiles of DHT were unrelated to LUTS incidence (all p≥0.25). In symptomatic men, relative to the lowest quantile, all quintiles of serum testosterone and all quintiles of DHT were unrelated to LUTS progression (all p≥0.17). There was no significant interaction between treatment with dutasteride and serum testosterone or DHT when predicting LUTS; as such, data were not stratified by treatment assignment. CONCLUSIONS: In the REDUCE study, higher serum testosterone and higher serum DHT were not associated with either incident LUTS in asymptomatic men or progression of LUTS in symptomatic men. These data do not support the hypothesis that serum androgen levels in middle-aged men are associated with LUTS. Source of Funding: Dr. Daniels is funded by the NIH grants TL1 DK132768 and U2C DK129496 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e71 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Daniels More articles by this author James Mirocha More articles by this author Daniel Moreira More articles by this author Gerald Andriole More articles by this author Stephen Freedland More articles by this author Expand All Advertisement PDF downloadLoading ...

MP59-10 ADOPTION, SAFETY, AND EFFICACY OF HoLEP FOR BENIGN PROSTATIC HYPERPLASIA IN THE UNITED STATES

You have accessJournal of UrologyCME1 Apr 2023MP59-10 ADOPTION, SAFETY, AND EFFICACY OF HoLEP FOR BENIGN PROSTATIC HYPERPLASIA IN THE UNITED STATES Ilon Weinstein, Camilo Arenas-Gallo, Xian Wu, Danly Omil-Lima, Aaron Brant, Bashir Al Hussein Al Awamlh, Christopher Gaffney, Irina Jaeger, and Jonathan Shoag Ilon WeinsteinIlon Weinstein More articles by this author , Camilo Arenas-GalloCamilo Arenas-Gallo More articles by this author , Xian WuXian Wu More articles by this author , Danly Omil-LimaDanly Omil-Lima More articles by this author , Aaron BrantAaron Brant More articles by this author , Bashir Al Hussein Al AwamlhBashir Al Hussein Al Awamlh More articles by this author , Christopher GaffneyChristopher Gaffney More articles by this author , Irina JaegerIrina Jaeger More articles by this author , and Jonathan ShoagJonathan Shoag More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) was developed as a more efficient method of surgically managing benign prostatic hyperplasia (BPH) than the gold standard transurethral resection of the prostate (TURP). While institutional studies have demonstrated HoLEP to have comparable efficacy and reduced peri-operative morbidity compared to TURP, little is known of its adoption, safety, and efficacy in the community. We compare readmission and retreatment rates of HoLEP to other widely used endoscopic procedures for BPH including TURP, photoreceptive vaporization of the prostate (PVP), and Urolift. METHODS: Men who underwent endoscopic treatments for BPH from 2000-2019 were identified in the service-level, hospital-based, all-payer claims Premier Healthcare Database (n=218,793). We compared the relative proportion of each procedure performed and annual physician volume data to identify trends in adoption and utilization. Readmission and retreatment rates were determined at both 30- and 90- days post-operation. Multivariable logistic regression was used to assess association between procedure type and outcomes. RESULTS: HoLEP accounted for 3.2% (n=6,967) of all BPH procedures performed between 2000 and 2019 and increased from 1.1% of procedures in 2008 to 4% in 2019. From 2008-2019 the mean annual number of HoLEP cases per physician increased from 2.03 to 7.23. Patients receiving HoLEP demonstrated lower odds of 90-day readmission compared to TURP (OR 0.87, p=0.025). HoLEP demonstrated similar odds of retreatment compared to TURP at both 1-year (OR 0.96, p=0.7) and 2-years (OR 0.98, p=0.9), while patients undergoing PVP and Urolift were more likely to be retreated within 2-years (OR 1.20, p<0.001; OR 1.87, p<0.001). CONCLUSIONS: HoLEP remains a safe therapy for BPH with lower readmission and comparable retreatment rates to the gold standard TURP. Despite this, the adoption and utilization of HoLEP has lagged behind other endoscopic procedures like TURP, Urolift, and PVP over the past two decades. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e811 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ilon Weinstein More articles by this author Camilo Arenas-Gallo More articles by this author Xian Wu More articles by this author Danly Omil-Lima More articles by this author Aaron Brant More articles by this author Bashir Al Hussein Al Awamlh More articles by this author Christopher Gaffney More articles by this author Irina Jaeger More articles by this author Jonathan Shoag More articles by this author Expand All Advertisement PDF downloadLoading ...