Current Practice Patterns in the Surgical Management of Benign Prostatic Hyperplasia

Area of Science:

• Urology
• Surgical Practice Analysis

Background:

• Benign prostatic hyperplasia (BPH) is a common condition requiring surgical intervention.
• Multiple surgical modalities exist for BPH, leading to variations in practice patterns.

Purpose of the Study:

• To analyze trends and practice patterns in BPH surgery using American Board of Urology (ABU) case log data.
• To identify surgeon-specific factors influencing the choice of BPH surgical procedures.

Main Methods:

• Retrospective analysis of ABU case logs from 2008 to 2021.
• Logistic regression models were employed to determine factors associated with surgical modality utilization.

Main Results:

• Transurethral resection of the prostate (TURP) was the most frequent BPH surgery, with increasing odds over time.
• Prostatic urethral lift (PUL) adoption surged post-2015, now accounting for over a third of BPH surgeries.
• Holmium laser enucleation of the prostate (HoLEP) use remained stable and was associated with higher surgical volume and endourology subspecialization.

Conclusions:

• TURP persists as the dominant BPH surgical procedure in the US despite technological advancements.
• PUL demonstrates rapid adoption, while HoLEP represents a consistent but smaller proportion of BPH surgeries.
• Surgeon and patient demographics, along with urologist subspecialization, correlate with specific BPH surgical approach selection.