Surgical Treatment Of Benign Prostatic Hyperplasia Research Articles

Evaluation of the clinical efficacy of transurethral bipolar surgery and laser technologies in the treatment of patients with benign prostatic hyperplasia

BACKGROUND: Benign prostatic hyperplasia (BPH) is common middle-aged and elderly men. In modern urology, transurethral resection and its modifications are used in surgical treatment of BPH. In the last decades, an active tendency of laser technologies development in urology was noted. The search for the most appropriate techniques of transurethral removal of prostate adenoma by comparing the results of treatment of patients with the use of different technologies remains relevant. AIM: This study aimed to evaluate the clinical effectiveness of transurethral bipolar surgery and laser technologies in the treatment of BPH. MATERIALS AND METHODS: Transurethral enucleation of the prostate using various technologies was performed in 273 patients with BPH between 2021 and 2023: 94 patients underwent bipolar transurethral enucleation of the prostate, 87 underwent thulium enucleation of the prostate (ThuLEP), and 92 underwent holmium enucleation of the prostate (HoLEP). RESULTS: Clinical evaluation showed the absence of intraoperative complications. For ThuLEP, a trend toward shorter operative times compared to other techniques was observed. In the early postoperative period, significant bleeding was noted in six cases of using bipolar technology, three cases of using a thulium laser, and five cases of using a holmium laser. An examination of patients 6 months postsurgery showed pronounced positive dynamics in all three groups. No significant differences were found in clinical parameters 6 months postsurgery in patients of different groups. CONCLUSIONS: Bipolar enucleation of the prostate, ThuLEP, and HoLEP are comparable in effectiveness and the number of complications in the surgical treatment of BPH. Study results indicated that it is advisable to actively use these methods in wide clinical practice.

Advances in HoLEP technology and technique – Current state of play

Background: Until recently, Holmium laser enucleation of the prostate (HoLEP) utilisation has been limited despite its perceived benefits over alternative surgical and minimally invasive benign prostatic hyperplasia (BPH) treatments. Objective: The purpose of this review is to highlight our experience with recent advances in laser and morcellator technologies that have made it easier for urologists to consistently offer HoLEP as a safe, efficient, and effective in an ambulatory (day surgery) setting. Methods: Our narrative review focused on contemporary studies published within the last five years. Conclusions: Technological advances coupled with increasing availability of training opportunities has and will continue to improve patients’ accessibility to the gold standard in BPH surgical treatment. Furthermore, we will describe refinements in laser enucleation techniques that have improved procedural efficiencies, rates of temporary post-operative urinary incontinence, and preservation of sexual function. The effects of technical modifications on functional and durability outcomes are to be seen in further prospective studies. Level of Evidence: Level 7 (Expert Opinion)

An analysis of benign prostatic hyperplasia surgical treatment reimbursement trends across Canada Examining provincial changes over the recent decade with comparison to cost of living changes.

A variety of procedures for the endoscopic surgical treatment of symptomatic benign prostatic hyperplasia (BPH) refractory to medical therapy have existed for decades. The present study examined trends in surgeon compensation for these treatments within Canada. The physician fee schedule for BPH surgery across 10 Canadian provinces for the years 2010 and 2023 were obtained. A descriptive study examined first the provincial reimbursement for transurethral resection of prostate (TURP) and laser ablative/enucleation surgery; second, the difference in TURP reimbursement between 2010 and 2023; and third, the annual change in TURP reimbursement juxtaposed with the annual change in the provincial Consumer Price Index (CPI) and annual salary for the working population aged 35-44. Seven of 10 Canadian provinces reimburse laser BPH surgery equally to TURP. The average provincial TURP reimbursement is $545, ranging from $451 in Ontario to $688 in Saskatchewan. Since 2010, TURP reimbursement has varied by province from a 0% net change in Ontario to an increase of 21% in Nova Scotia. Reimbursement for TURP has increased at a slower pace than the local CPI, and for half of the provinces at a slower pace than the annual salary for people aged 35-44. The compensation model for endoscopic BPH surgery does not have a unified structure in Canada that is consistent across provinces, nor does it keep up with inflation, possibly impacting future recruitment, increasing geographic disparities, and most importantly, limiting the adoption of new BPH therapies.

Benign Prostatic Hyperplasia Surgery: A Snapshot of Trends, Costs, and Surgical Retreatment Rates in the USA

BackgroundAn increasing number of novel surgical treatments (NSTs) for benign prostatic hyperplasia (BPH) have been proposed over time to achieve similar functional outcomes to, but better perioperative and sexual outcomes than traditional procedures. ObjectiveTo 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. Design, setting, and participantsA 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. Outcome measurements and statistical analysisThe 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. Results and limitationsIn 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. ConclusionsOver 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. Patient summaryWe 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.

Effect of endoscopic enucleation of the prostate on erectile and ejaculatory function

Benign prostatic hyperplasia (BPH) is a highly prevalent condition in older men, often associated with both lower urinary tract symptoms (LUTS) and reduced quality of sexual life. During the past three decades, researchers have focused on improving new operative techniques to reduce complications of traditional surgery for BPH, such as urethral stricture, stress urinary incontinence. Surgeons have increased interest in investigating the relationship between surgical treatment and postoperative sexual dysfunction such as erectile and ejaculatory dysfunction, as the demand to minimise adverse events has become a concern for more patients. In view of the above, this paper aims to systematise information on the quality of sexual life of patients after surgical treatment of BPH. This work has shown that this problem remains topical to nowadays. It is noteworthy that only a limited number of well-designed, randomised studies exist on this issue. This is mainly due to the unavailability of a uniform methodology for assessing sexual function in surgically treated BPH-patients.

Effects of resection volume on postoperative micturition symptoms and retreatment after transurethral resection of the prostate

PurposeDespite advances in technology, such as advent of laser enucleation and minimally invasive surgical therapies, transurethral resection of the prostate (TURP) remains the most widely performed surgical technique for benign prostatic hyperplasia (BPH). We evaluated resection volume (RV)-derived parameters and analyzed the effect of RV on post-TURP outcomes.MethodsThis observational study used data from patients who underwent TURP at two institutions between January 2011 and December 2021 Data from patients with previous BPH surgical treatment, incomplete data, and underlying disease affecting voiding function were excluded. The collected data included age, prostate-specific antigen, transrectal ultrasound (TRUS)- and uroflowmetry-derived parameters, RV, perioperative laboratory values, perioperative International Prostatic Symptom Score (IPSS), follow-up period, retreatment requirements and interval between the first TURP and retreatment.ResultsIn 268 patients without prior BPH medication, there were no differences in prostate volume (PV), transitional zone volume (TZV), or RV according to IPSS. A total of 60 patients started retreatment, including medical or surgical treatment, within the follow-up period. There was a significant difference in RV/PV between the groups without and with retreatment respectively (0.56 and 0.37; p = 0.008). However, preoperative TRUS- and uroflowmetry-derived parameters did not differ between the two groups. Multiple linear regression analysis showed that RV (p = 0.003) and RV/TZV (p = 0.006) were significantly associated with differences in perioperative IPSS. In the multivariate logistic regression analysis, only RV/PV was correlated with retreatment (p = 0.010).ConclusionMaximal TURP leads to improved postoperative outcomes and reduced retreatment rate, it may gradually become a requirement rather than an option.

Current Evidence on Surgical Management for Benign Prostatic Hyperplasia in Renal Transplant Recipients: A Systematic Review.

Background: Patients who have undergone renal transplant may have a concomitant benign prostatic hyperplasia (BPH), a condition that can potentially hinder the recovery of the renal graft and necessitate surgical intervention. However, endoscopic treatment of BPH should be performed carefully because of the associated perioperative risks. We aimed to systematically assess the factors affecting surgical indications and perioperative outcomes of BPH surgical treatment in renal transplantation (RT) recipients. Methods: A systematic literature search was performed on January 28, 2023, using Scopus, PubMed, and EMBASE with no date limit. Preclinical and animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Results: Eighteen articles were accepted and included. Clinical BPH has a high incidence rate after RT, particularly in elderly men. Secondary events associated with BPH, such as acute urinary retention and urinary tract infections, can lead to a gradual decline of renal graft function and patient survival. BPH procedure can prevent these events and guarantee improvements in serum creatinine levels, voiding parameters, and lower urinary tract symptoms. When the urine culture is negative, the endoscopic procedure of the prostate may be performed within 1 month of the initial procedure, particularly in older patients, more prone to develop voiding dysfunction. Alternatively, a transurethral incision of the prostate may be recommended for patients with smaller prostates who wish to preserve ejaculatory function. Data on comparative BPH surgical procedures are lacking. Conclusions: BPH procedure should be offered in RT recipients who develop bladder outlet obstruction owing to BPH. Endoscopic treatment should be performed after a few weeks from RT to avoid further graft deterioration.

Is Race Associated with the Surgical Treatment for Benign Prostatic Hyperplasia? An Analysis of 30,000 Medicare Lives

BackgroundsWith an increased prevalence and burden of benign prostatic hyperplasia (BPH), effective and equitable treatment is a priority. Limited data exist evaluating treatment disparities for patients with BPH by race. This study examined the association between race and BPH surgical treatment rates among Medicare beneficiaries.MethodsMedicare claims data were used to identify men newly diagnosed with BPH from January 1, 2010 through December 31, 2018. Patients were followed until their first BPH surgery, a diagnosis of prostate/bladder cancer, termination of Medicare enrollment, death, or end of study. Cox proportional hazards regression compared the likelihood of BPH surgery between men of different races (White vs. Black, Indigenous, and People of Color (BIPOC)), controlling for patients’ geographical region, Charlson comorbidity score, and baseline comorbidities.ResultsThe study included 31,699 patients (13.7% BIPOC). BIPOC men had significantly lower BPH surgery rates (9.5% BIPOC vs. 13.4% White; p=0.02). BIPOC race was associated with a 19% lower likelihood of receiving BPH surgery than White race (HR, 0.81; 95% CI 0.70, 0.94). Transurethral resection of the prostate was the most common surgery for both groups (49.4% Whites vs. 56.8% BIPOC; p=0.052). A higher proportion of BIPOC men underwent procedures in inpatient settings compared to White men (18.2% vs. 9.8%; p<0.001).ConclusionsAmong a cohort of Medicare beneficiaries with BPH, there were notable treatment disparities by race. BIPOC men had lower rates of surgery than White men and were more likely to undergo procedures in the inpatient setting. Improving patient access to outpatient BPH surgical procedures may help address treatment disparities.

Prostatic Artery Embolization for The Treatment of Benign Prostatic Obstruction - A Retrospective Review of The Novel Experience Of 2 Tertiary Urology Centers

Background: Benign Prostatic Hyperplasia (BPH) is common in aging men with worldwide prevalence at 20-62%, while Malaysian prevalence was 39.3% (2001) and increased at 8% per decade. In surgical treatment of BPH, Trans-Urethral Resection of Prostate (TURP) remains the gold standard. Other surgical options would mostly also require general anesthesia (GA). Therefore, more Local-Anaesthesia (LA) based options should be made available for patients who are not fit or unwilling to be under GA. Those currently available LA-based procedure has shown promising results including prostatic stents and trans-urethral lifts, but have drawbacks due to being expensive, not widely available, less suitable in median lobe enlargement or may cause complications including migration, overgrowth of prostatic tissue or foreign-body related complications which may require GA for their treatment. Prostatic Artery Embolization (PAE), initially an LA-based emergency treatment option for persistent life-threatening hematuria from a bleeding BPH, now has been proven to be a safe elective treatment. In Malaysia this novel technique was first reported in 2017 for treatment of post TURP intractable hematuria. Methods and Material: We retrospectively evaluated all 13 catheter-dependent BPH patients in two tertiary urology centres treated with PAE from April 2019 until December 2021 to assess post-treatment efficacy. Results: One patient failed removal of catheter within 3 months post-procedure but 12 out of 13 patients safely got their catheter removed within 1-3 months and resulted in significant IPSS improvement. Conclusion: PAE is a safe and effective treatment option for BPH patients of the Malaysian population but needs prospective evaluation.

Оценка тестостеронзаместительной терапии при реабилитации мужчин с нарушениями мочеиспускания после хирургического лечения ДГПЖ.

Introduction. Symptoms of lower urinary tract dysfunction (LUTS) in older men are most often associated with benign prostatic hyperplasia (BPH). A low level of testosterone leads to various changes in the organs and systems of the body, including causing structural changes in the tissues of the genitourinary system, which negatively affects their function. The aim of this work was to study the effect of testosterone replacement therapy on LUTS with androgen deficiency in patients after surgical treatment of BPH. Materials and methods. The analysis of observation and treatment of LUTS in 101 patients operated on for BPH was performed. The patients are divided into three groups. Group A (n=48) included patients with normal testosterone levels receiving conservative therapy for moderate LUTS. Groups B (n=38) and C (n=21) included patients with SNIP and low testosterone levels. In order to correct the level of testosterone in patients in group C, after surgical treatment, androgen replacement therapy was prescribed. For primary diagnosis and evaluation of the effectiveness of the treatment vinitial and during periods of 1, 3, 6 and 12 months, general clinical examination methods, the International Pancreatic Symptom Scale (IPSS) questionnaire, urination diaries (DM), uroflowmetry, and ultrasound examination of the pancreas and bladder were used. Results. According to the IPSS questionnaire, patients in group B had more pronounced manifestations of LUTS compared with patients in groups A and C due to accumulation symptoms. At the same time, by prescribing androgen replacement therapy, it was possible to achieve an increase in the level of total testosterone in patients of group C to «physiological values», corresponding to patients in group A. According to the results of the analysis of DM data, it was found that in patients in all observation groups, the number of urination per day decreased (p&lt;0.001) with an increase in the functional capacity of the bladder. The highest values of the maximum micturition volume, at the end of the observation period, were recorded in patients in group A, the minimum micturition volume and the most pronounced decrease in episodes of nocturia and nocturia index – in patients in group C. Temporal values of the accumulative bladder function also indicate a more pronounced decrease LUTS in group C. Conclusions. The use of androgen replacement therapy increases the effectiveness of LUTS treatment in patients with androgen deficiency after surgical treatment of BPH.

Medico-Surgical Therapeutic Management of Benign Prostatic Hyperplasia

Although benign prostatic hyperplasia (BPH), a condition that affects many elderly people, is frequent, surgical treatment for BPH has advanced significantly in comparison to medicinal care. Instead of addressing the disease itself, medical treatment just addresses the symptoms. Due to the fact that the majority of senior patients will have comorbid conditions like diabetes and hypertension, surgery may not be an option for everyone, making medical care more widely available. Notably, even while TURP, TUIP, TVP, TUMT, and TUNA continue to be the gold standards for treatment, medicinal therapy still offers hope for recovery and averting surgery. But one must be aware of the recently identified negative effects that these drugs can have in the elderly male, especially over a lengthy period of time. Though they are not appropriate for every patient, novel minimally invasive procedures have shown promise for the elderly male who has failed medicinal therapy but is not a surgical candidate or wishes to avoid surgery. Before choosing a course of treatment for your BPH patient, it’s crucial to talk with them about the risks, advantages, side effects, and alternatives.

СОСТОЯНИЕ КОПУЛЯТИВНОЙ ФУНКЦИИ У ПАЦИЕНТОВ ПОСЛЕ ТРАНСУРЕТРАЛЬНОЙ МЕХАНИЧЕСКОЙ ЭНУКЛЕАЦИИ БИПОЛЯРНЫМ ЭЛЕКТРОДОМ ДОБРОКАЧЕСТВЕННОЙ ГИПЕРПЛАЗИИ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

Aim. Today, the problem of treating sexual disorders does not have limitations on the age factor; in this connection, the state of copulatory function (CF) in patients after surgery for benign prostatic hyperplasia (BPH) is an important aspect. In the world and domestic literature, there are very few works that comprehensively evaluate the effect of bipolar transurethral mechanical enucleation (TUEB) on the state of CF in general with a parallel study of reflex and hormonal. Objective. To study the effect of TUEB on the state of CF, reflex and hormonal status. Materials and methods. The results of the treatment of 102 patients who underwent TUEB (n=102). IPSS scores and quality of life index, IIEF, AMS questionnaire scores, ICF scale, bulbocavernous reflex (BCR), testosterone fractions (TF) and sex hormone-binding globulin (SHBG) were investigated. The patients were examined preoperatively, 6 and 12 months later. Results. Progressive improvement in erectile function (EF) after surgical treatment with the TUEB method. The duration of the latent period of BCR decreased, indicating an improvement in reflex status, as well as an increase in the duration of nocturnal sleep with a parallel increase in testosterone concentration in the operated patients. Conclusions. Surgical treatment of BPH through the application of TUEB in general shows duality of influence on the state of EF, consisting of positive influence (improvement of EF) and negative influence, which is expressed in increased specific weight of patients with postoperative hypoorgasmia (HO) and retrograde ejaculation (RE). This technique was found to improve reflex and hormonal status.

Prostat lazer cerrahileri sonrası erektil ve ejakülatuvar fonksiyonlar

Benign prostatic hyperplasia (BPH) is a common health condition in aging men resulting in lower urinary tract symptoms (LUTS) and poor quality of life. Until recently, transurethral prostatectomy (TUR-P) was considered the gold standard for prostate surgery, but prostate enucleation methods using advanced laser technologies have become a strong competitor to TUR-P and have become widely used. The effects of all surgical procedures performed for prostate on sexual functions have been the subject of many studies. In today’s world where quality of life is emphasized and technological advances are increasing, the search for treatment methods with minimal effect on sexual function in the surgical treatment of BPH has increased. In this review, the effects of laser surgeries in the treatment of BPH on erectile and ejaculatory function will be presented with the current literature. Keywords: benign prostatic hyperplasia, HOLEP, ThuFLEP, erectile function, ejaculatory function

Оценка эффективности и безопасности лазерной энуклеации предстательной железы у пациентов разных возрастных групп.

Introduction. The influence of the age phenomenon on the outcome of the surgical treatment of benign prostate hyperplasia (BPH) research is insufficient. Considering the wide use of the more advanced laser enucleation method in the surgical treatment of BPH, there is a need to evaluate the efficiency and safety of this technique among aged patients compared to younger age groups. In this review the task was to evaluate the impact of the age phenomenon on the result of treatment, using the available scientific literature. Materials and methods. Articles were searched in three databases (Pubmed, Scopus and Web of Science) using the following request: «laser enucleation», «prostate», «elderly patients», «older patients» and «age». The unsystematic review of 7 works in English containing original data demonstrated the results of different types of enucleation among the patients with a clear stratification of groups by age for the period 2013-2022 was made. Results. Тhe absolute majority of studies do not show significant differences between the age groups regarding the preoperative IPSS, Qmax, post-void residual (PVR), however, a high frequency of chronic diseases in the older age group is noticed. In most studies, no significant differences in a number of complications according to Clavien-Dindo were found. Only in one study P. Gild et al., where large samples were researched, the frequency of blood transfusions and a number of complications ≥3b, were much higher in a group of patients over 80 y.o. and older comparing to younger-aged groups: 0 (0%), 8 (1,3%), 22 (2,7%), 14 (8,2%) for the group under 60 years old, 60-69 years old, 70-79 years old, 80 years and older, respectively (p&lt;0,001); 2 (1,5%), 12 (1,9%), 34 (3,9%), 13 (7,1%), for these groups, respectively (p=0,02). Regarding the postoperative Qmax, despite of significant improvement of this indicator in all age groups, worse results are noticed in older patients group comparing to the results of patients in younger groups. However, the tendency to balance the marked differences with a long observation period is also noticed. Conclusions. Laser enucleation of the prostate is the effective and safe method for prostatic hyperplasia treatment for the patients of any age. However, available data about bad results after the surgical treatment among elderly patients and a higher frequency of complications show the need of the further research of this topic and evaluation of the surgical treatment at an earlier age.

Лазерные технологии в лечении доброкачественной гиперплазии предстательной железы.

Introduction. Benign prostatic hyperplasia (BPH) is a common disease among men over 40 years old. Transurethral resection of the prostate has traditionally been considered the «gold standard» for surgical treatment of patients with BPH. The emergence and popularization of laser energy has led to the development of surgical technologies that can closely approach, and in some cases even exceed the effectiveness and safety of TURP. Materials and тethods. The data were searched in the PubMed, Web of Scince. databases of Google Scholar and the scientific electronic library eLibrary.RU using the following keywords: benign prostatic hyperplasia, surgical treatment; transurethral resection of the prostate; tulium laser; holmium laser; photoselective vaporization; GreenLight system; laser energy; cost-effectiveness. Among all currently available laser energies the greatest number of publications is devoted to the use of holmium and thulium energy for laser enucleation of the prostate (HoLEP and THuLEP). Results. The effectiveness of HoLEP has been well studied with papers on the use of this technique, including numerous randomized controlled trials. The safety and efficacy of surgical intervention in patients with a large prostate volume (&gt;100 g) was confirmed in 2000. The efficacy of the procedure was comparable to open surgery, while perioperative morbidity was lower in the group of patients who underwent HoLEP. The Tulium laser has a wavelength of 2013 nm and a penetration depth of 0.25 mm, using water as an absorbing chromophore. Unlike the holmium laser, energy is released in a continuous visible mode. This energy for the treatment of patients with BPH was first used in 2015. ThuLEP was studied in a metaanalysis by Kyriazis et al. Four studies (two randomized studies comparing ThuLEP with TURP or HoLEP and two prospective cohort studies with a follow-up period of 3-24 months) were included in this work. The authors reported an 87% reduction in prostate volume, a significant change in Qmax and IPSS, on par with TURP. Conclusion. A large variety of laser surgical systems are currently available, differing in the types of laser energy used. Surgical treatment of BPH can be performed using any method of laser surgery. The most promising and safe method for BPH treatment is the use of tulium laser energy. However, there is insufficient data on the cost-effectiveness of laser technologies.

Benign prostatic hyperplasia surgical treatment trends in the Public Health System in São Paulo, Brazil

ABSTRACTObjective To describe and compare the number of surgeries, mortality rate, length of hospital stay, and costs of transurethral resection of the prostate and open prostatectomy for the treatment of benign prostatic hyperplasia, between 2008 and 2018, in the Public Health System in São Paulo, Brazil.Methods Ecological and retrospective study using data from the informatics department of the Brazilian Public Health System database. Procedure codes were “open prostatectomy” and “transurethral resection of the prostate.” The outcomes analyzed were compared between transurethral resection of the prostate and open prostatectomy according to the hospital surgical volume and presence or absence of a residency program.Results A total of 18,874 surgeries were analyzed (77% transurethral resection of the prostate) and overall mortality was not statistically different between procedures. Intermediate and high-volume centers had shorter length of hospital stay than low-volume centers for transurethral resection of the prostate (3.28, 3.02, and 6.58 days, respectively, p=0.01 and p=0.004). Length of hospital stay was also shorter for open prostatectomy in high-volume compared to low-volume centers (4.86 versus 10.76 days, p=0.036). Intrahospital mortality was inversely associated with surgical volume for transurethral resection of the prostate. Centers with residency program had shorter length of hospital stay considering open prostatectomy and less mortality regarding transurethral resection of the prostate. Open prostatectomy was 64% more expensive than transurethral resection of the prostate.Conclusion The findings suggest the importance of investing in specialized centers, which could be potential referral centers for surgical cases.

Is the systematic histological analysis of benign prostatic hyperplasia surgical specimen always necessary?

After most surgical management of benign prostatic hyperplasia (BPH), the resected tissue undergoes a histological examination. This examination is performed for the risk of finding an incidental prostate cancer (iPCa). The improvement of prostate cancer detection in the past few years decreased the global iPCa rate. This raises the question of the real benefit for all patients of a systematic histological analysis. The aim of our study was to evaluate the iPCa detection rate on a large contemporary cohort of patients treated for BPH, and to define predictive factors of iPCa detection. We retrospectively analyzed the medical charts of all consecutive patients who underwent surgical treatment for BPH in our academic center from 2012 to 2018. Patients with prostate cancer diagnosed before surgery were not included. All the resected tissue underwent standard histopathological examination. iPCa was defined by any grade or stage of prostate cancer identified on the resected tissue by the histological examination. The following variables were analyzed using an uni- and multi-variable logistic regression as potential risk factors of iPCa: age, total PSA, PSA density (PSAd), prostate volume, technique used, weight of resected tissue and use of 5ARI medication. 1045 patients were included in the study. Of them, 439 (42.0%), 206 (19.7%) and 400 (38.3%) underwent HoLEP, OP and TURP, respectively. iPCa was diagnosed in 94 (9.0%) of the 1045. Among them 15 (1.4%) were clinically significant (ISUP score ≥ 2). The multivariable logistic regression analysis identified age (p = 0.03) and PSA density (p < 0.001) as independent predictive factors for the detection of iPCa. Using the median of age and PSAd, we identified a population with 0% of iPCa in our cohort (age < 70year-old and PSAd < 0.05ng/mL/mL). The global iPCa rate was 9% in this contemporary large cohort of patients who underwent surgical treatment for BPH, with 1.4% of clinically significant cancer. Age and PSAd were independent predictive factors to find iPCa. Patients younger than 70 with a PSAd < 0.05ng/mL/mL had 0% of iPCA in our cohort. In this specific population, we could probably avoid a systematical histological examination of the resected tissue.

PD39-02 DOES RACE INFLUENCE THE SURGICAL TREATMENT FOR BENIGN PROSTATIC HYPERPLASIA? - AN ANALYSIS OF 30,000 MEDICARE LIVES

You have accessJournal of UrologyCME1 May 2022PD39-02 DOES RACE INFLUENCE THE SURGICAL TREATMENT FOR BENIGN PROSTATIC HYPERPLASIA? - AN ANALYSIS OF 30,000 MEDICARE LIVES Gopal L. Narang, Sirikan Rojanasarot, Michael Murphy, Ben Cutone, and Mitchell R. Humphreys Gopal L. NarangGopal L. Narang More articles by this author , Sirikan RojanasarotSirikan Rojanasarot More articles by this author , Michael MurphyMichael Murphy More articles by this author , Ben CutoneBen Cutone More articles by this author , and Mitchell R. HumphreysMitchell R. Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002597.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The prevalence of benign prostatic hyperplasia (BPH) is increasing globally. With a greater disease burden, effective but also equitable treatment is a priority. There is little data evaluating treatment disparities for patients with BPH, specifically when considering race. This study examines the association between race and rates of BPH surgical treatment among Medicare beneficiaries. METHODS: This real-world data analysis used 5% Medicare claims data to identify newly diagnosed men with BPH, age 66, between January 2010 and December 2018. Patients were followed until either their first BPH surgery, a diagnosis of prostate or bladder cancer, end of continuous Medicare enrollment, death, or end of the study period. Cox proportional hazards regression compared the likelihood of BPH surgery between men of different races, White vs. Black, Indigenous and People of Color (BIPOC), controlling for patients’ geographical region, Charlson Comorbidity Score, and baseline comorbidities. RESULTS: The study included 31,699 men with BPH; 13.7% were BIPOC. The median follow-up was 3.6 years (IQR 1.7-6.0) for White men and 2.8 years (IQR 1.3-5.2) for BIPOC men. At the end of the study period, BIPOC men had significantly lower BPH surgery rates than White patients (9.5% vs. 13.4%, respectively; p=0.02). In multivariable-adjusted Cox regression, BIPOC race was associated with a 19% lower likelihood of receiving BPH surgery than White race (HR, 0.81; 95% CI 0.70, 0.94). Among those who had surgery, transurethral resection of the prostate was the most common surgery for both White and BIPOC groups (49.4% vs. 56.8%, respectively; p=0.05). A higher proportion of BIPOC men underwent procedures in inpatient settings compared to White men (18.2% vs. 9.8%; p=0.00). CONCLUSIONS: Among a cohort of Medicare beneficiaries with BPH, there are notable treatment disparities when considering race. BIPOC men had lower rates of surgical treatment than White men with no difference in the type of procedure performed. BIPOC men were more likely to undergo procedures in inpatient settings. Improving patient access to BPH surgical procedures that can be performed in an outpatient setting may help address treatment disparities. Future research investigating treatment barriers and implications of site of service on access to care are needed. Source of Funding: Boston Scientific © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e652 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gopal L. Narang More articles by this author Sirikan Rojanasarot More articles by this author Michael Murphy More articles by this author Ben Cutone More articles by this author Mitchell R. Humphreys More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Predictive Factor for Favorable Outcome after Surgical Treatment of Benign Prostate Hyperplasia Performed by Young Urologist: Is Surgical Modality Important in Beginner Urologists?

Objective: To identify predictive factors for favorable outcomes after surgical treatments that were performed by beginner urologists in patients with benign prostate hyperplasia (BPH), we retrospectively evaluated outcomes after holmium laser enucleation of the prostate (HoLEP) and transurethral resection of prostate (TURP) that were performed by two young urologists.Methods: Of 80 patients who were treated with HoLEP or TURP, 31 (HoLEP) and 36 (TURP) patients who were followed up for 3 months were enrolled in this study. Preoperative and perioperative variables were evaluated to identify predictive factors for favorable outcome after surgical treatment for BPH.Results: At 3 months postoperative after HoLEP or TURP, the median decrease in International Prostate Symptom Score (IPSS) was 13.0. Patients whose IPSS decreased by over 13 points were categorized into a favorable response group after HoLEP or TURP. Univariate and multivariate logistic regression analyses were performed to identify predictors of favorable outcomes at 3 months after HoLEP or TURP, and the preoperative IPSS was identified as an independent predictor for favorable outcomes.Conclusion: When young urologists plan to perform surgical treatment for BPH, they should consider that the severity of symptoms is the most important factor for favorable outcomes. The type of surgical modality for managing BPH is less important.

Statin Use and Lower Urinary Tract Symptoms Incidence and Progression in Reduction by Dutasteride of Prostate Cancer Events (REDUCE) Trial.

Benign prostatic hyperplasia (BPH) is a common disease often manifested by lower urinary tract symptoms (LUTS). We previously found statins were associated with modest attenuations in prostate growth over time in REDUCE. We tested whether statins were associated with LUTS incidence in asymptomatic men and LUTS progression in symptomatic men. We performed a post-hoc analysis of REDUCE in 3,060 "asymptomatic" men with baseline International Prostate Symptom Score (IPSS) <8 and in 2,198 symptomatic men with baseline IPSS ≥8 not taking α-blockers or 5α-reductase inhibitors. We used multivariable Cox regression models to assess associations between statin use at baseline and LUTS incidence and progression. Among asymptomatic men, incident LUTS was defined as the first reported medical or surgical treatment for BPH or sustained clinically significant LUTS (2 reports of IPSS >14). Among symptomatic men, LUTS progression was defined as IPSS increase ≥4 points from baseline, any surgical procedure for BPH, or initiation of a BPH drug. Among asymptomatic and symptomatic men, 550 (18%) and 392 (18%) used statins at baseline, respectively. On multivariable analysis, statin use was not associated with LUTS incidence (HR 1.05; 95% CI 0.78-1.41, p=0.74) in asymptomatic men, or with LUTS progression (HR 1.13; 95% CI 0.96-1.33, p=0.15) in symptomatic men. Similar results were seen in the dutasteride and placebo arms when stratified by treatment assignment. In REDUCE, statin use was not associated with either incident LUTS in asymptomatic men or LUTS progression in symptomatic men. These data do not support a role for statins in LUTS prevention or management.