[Contemporary surgical management of benign prostatic obstruction in Germany : A population-wide study based on...

The surgical management of benign prostatic obstruction (BPO) has greatly evolved in recent years.

The aim of this study is to present contemporary management and trends for surgical BPO therapy in Germany.

Disease and procedure rates were extracted using the online platform reimbursement.INFO that is based on German hospital quality report data. For the diagnosis of benign prostate hyperplasia (BPH), the ICD codes N40 and D29.1 were used. For evaluation of the surgical procedures OPS codes 5‑600.0, 5‑601, 5‑603, 5‑609.4 and 5‑609.8 including their subcodes were used. In addition to descriptive analyses, trend and correlation analyses were performed.

In 2019, a total of 83,687 procedures for BPO in 473 urological departments were performed. The most common (71.7%) surgery was transurethral resection of the prostate (TUR-P). Holmium laser enucleation of the prostate (HoLEP; 9.5%) and surgical adenomectomy (5.6%) were the second and third most common procedures. Less often thulium laser enucleation (ThuLEP; 3.1%), laser vaporisation (2.9%) and electrical vaporisation (2.8%) were performed. All other techniques were performed in < 1%. Rates of HoLEP, ThuLEP and electrovaporisation have increased since 2006 (HoLEP: +42.42%/year, p < 0.001; ThuLEP: +20.6%/year, p = 0.99; electrovaporisation +43.42%/year, p < 0.001), while surgical adenomectomy decreased (-1.66%/year, p < 0.01). In 2019 mean length of hospital stay was 5.1 ± 0.1 days.

TUR‑P remains the most often performed surgical treatment for BPO. Laser therapy-especially in centers-is increasing, while surgical adenomectomy continues to abate.