Surgery for benign prostate enlargement in England: 10-year retrospective study of 155 874 patients

To analyse the trend in surgical interventions of benign prostate enlargement (BPE) in the UK National Health Service (NHS) in England (prostatic urethral lift, transurethral water vapour therapy, prostate artery embolisation, photoselective vaporisation of the prostate, transurethral incision of the prostate, holmium laser enucleation of the prostate, transurethral vaporisation of the prostate, transurethral resection of the prostate [TURP], and open surgery) and report prevalence of peri-procedural complications and subsequent risk of re-intervention.

A retrospective observational study using Hospital Episode Statistics to identify patients with BPE that received their first surgical treatment in any NHS hospital in England between April 2012 and November 2022. Patients were followed longitudinally until the end of the study or date of death. In-hospital (complications, length of stay), and longer-term outcomes (re-admission, re-treatment, death) were reported. A multivariable logistic regression model was built to analyse the relationship between associated odds of in-hospital complication and surgical modality. Kaplan-Meier analysis (stratified by age) and multivariable Cox regression analysis was performed to investigate the relationship between associated risk of re-intervention between treatments.

A total of 155 874 patients underwent their first surgical intervention to treat BPE. Less invasive treatments were associated with significantly decreased odds of in-hospital complication (compared to TURP). The effect of comorbidities and catheter on admission varied between treatments. Re-intervention rate within 5 years for interventions where there was sufficient follow-up varied from 3.1% (2.8-3.4%) to 19.6% (16.1-22.9%), less invasive treatments were associated with a significantly higher risk of re-intervention compared to TURP.

There is an increased uptake in minimally invasive treatments that require a shorter hospital stay and are associated with lower odds of treatment-related complications. However, the long-term effectiveness of these treatments varied, which should be taken into consideration by patients, clinicians and commissioners.