Evolution of the Endoscopic Surgical Approach for Benign Prostatic Obstruction in European Countries

Area of Science:

• Urology
• Surgical Oncology
• Health Services Research

Background:

• Endoscopic surgical approaches for benign prostatic obstruction (BPO) vary significantly across European nations.
• Trends in BPO treatment between 2018 and 2023 in Belgium, England, France, Germany, Spain, and Sweden were analyzed.

Purpose of the Study:

• To investigate the evolution and variations in endoscopic surgical treatments for BPO across six European countries.
• To compare procedural volumes, length of stay (LOS), and daycase rates for different BPO surgical techniques.

Main Methods:

• Analysis of publicly accessible procedure data, including procedural volumes and length of stay (LOS).
• Categorization of procedure codes for cross-country comparison and statistical analysis using general linear models and Poisson regression.
• Inclusion of data for 1,100,365 endoscopic surgical BPO procedures from 2018 to 2023.

Main Results:

• Significant variations in surgical volumes, treatment choices, LOS, and daycase rates were observed across the studied countries.
• A decline in transurethral resection of the prostate (TURP) from 74% to 64.5% was noted, with increases in laser treatments (8.2%) and minimally invasive surgical treatments (MIST) (1.11%).
• MIST procedures resulted in significantly shorter LOS and higher daycase rates compared to TURP (p < 0.001).

Conclusions:

• European BPO treatment is evolving towards more diverse endoscopic options, including laser and MIST procedures.
• Laser and MIST procedures demonstrate a lower impact on hospital capacity compared to TURP.
• Adoption of MIST and laser treatments can potentially alleviate hospital capacity constraints and reduce surgical waiting lists.