Related Experiment Video
Updated: Jul 12, 2025
Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser
Published on: May 9, 2018
Retreatment rates and postprocedural complications are higher than expected after BPH surgeries: a US healthcare
Steve Kaplan1, Ronald P Kaufman2, Thomas Mueller3
1Mount Sinai, New York, NY, USA. Steven.Kaplan@MountSinai.org.
Insights
Benign prostatic hyperplasia (BPH) surgery outcomes vary, with similar retreatment rates but differing complication risks across procedures. One in twenty patients may need retreatment within a year, and some may face complications.
Area of Science:
- Urology
- Surgical Outcomes Research
- Health Services Research
Background:
- Benign prostatic hyperplasia (BPH) affects a significant portion of aging men.
- Understanding the comparative risks and benefits of BPH treatments is crucial for shared decision-making.
Purpose of the Study:
- To compare the real-world outcomes of four common BPH surgical procedures.
- To evaluate retreatment rates and procedural complications within one and five years post-surgery.
Main Methods:
- Retrospective cohort study using US Medicare and commercial claims data (2015-2021).
- Included men undergoing Transurethral Resection of the Prostate (TURP), Photoselective Vaporization of the Prostate (PVP), Prostate Urethral Lift (PUL), or Water Vapor Thermal Therapy (WVTT).
- Assessed retreatment and complication rates using CPT and ICD codes, with adjustments for age and comorbidities.
Main Results:
- PUL showed the lowest complication rate (15%) at 1 year, while WVTT had the highest (26%).
- Retreatment rates at 1 year were similar across all procedures (5.3%-6.2%).
- At 5 years, TURP had the lowest retreatment rate (7.0%).
Conclusions:
- BPH surgical therapies are associated with varying complication risks, despite similar retreatment rates within the first year.
- Approximately 5% of patients may require retreatment within one year, irrespective of the chosen surgical procedure.
- A notable proportion of patients, up to 25% for some technologies, may experience complications requiring further treatment.
Background:
Up to 50% of men over 50 and 80% over 80 are affected by BPH. Shared decision-making regarding BPH treatment options can benefit from an improved understanding of relative risks and benefits for various treatments.
Methods:
Data for this longitudinal retrospective population-based cohort study were obtained from a random sample of US Medicare and commercial claims (IBM Watson MarketScan) and restricted to men undergoing BPH surgery (TURP, PVP, PUL, WVTT) from 2015 to 2021 across all sites of service. Retreatments included Holmium laser enucleation and index procedures. Main outcomes were rates of retreatment and procedural complications over 1 year, identified via CPT and ICD-9/10CM codes. Procedural complications that occurred at least 1 day post-index treatment were assessed, as were surgical retreatments with patients who had at least 1 and 5 year's-worth of data. Baseline phenotype characterization did not control for symptomatology and was limited to age, comorbidities, and BMI. Univariate cumulative incidence estimates, cumulative proportion and log-rank tests justified inclusion for covariate (e.g., age, comorbidities) adjustment in Cox proportional hazard models.
Results:
43,147 men diagnosed with BPH underwent 22,629 TURP, 11,392 PVP, 7,529 PUL, and 1,597 WVTT. At 1-year post-index: PUL was associated with the lowest rate of complication (PUL 15%, TURP 17%; PVP 19%, ; WVTT 26%); retreatment rates were not different (TURP 5.3%, PVP 5.3%, PUL 5.9%, WVTT 6.2%). At 5 years post-index: retreatment was lowest for TURP (7.0%) and was not significantly different between PVP and PUL (8.9% and 11.6%, respectively).
Conclusions:
Real-world patients diagnosed with BPH may be selected to undergo one of the various available therapies based on patient preference or baseline phenotype. These therapies, however, are associated with different risks for complications. The results of this study suggest that within one year of BPH surgery, one-in-twenty patients may require retreatment regardless of treatment choice, and for some technologies as many as one-in-four may require treatment for a complication.
Related Concept Videos
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
01:25Urinary Tract Calculi VI: Surgical Management