The 21st century marks a rise in TURP retreatment rates: an analysis of Veterans Health Administration data

With the advent of new and emerging procedures for benign prostatic hyperplasia (BPH), as well as a greater reliance on medical therapies, trainees may be receiving less exposure to the longstanding gold standard of treatment, transurethral resection of the prostate (TURP). Although TURP outcomes are generally durable, success rates vary. We sought to perform a descriptive analysis of temporal trends in TURP outcomes, evaluating whether those performed prior to 2001 were less likely to require re-operation compared to more contemporary TURP procedures.

We accessed the Veteran's Affairs (VA) national repository of electronic medical record data. We included veteran males with no prior BPH surgery who received a TURP. We used billing codes to determine retreatment and complications rates within 5 years of TURP. Outcomes were assessed via logistic regression analysis to compare TURP outcomes from before and after the year 2001. Comparisons between variables were done via Chi-Square test.

2,084 underwent TURP prior to 2001 and 35,817 underwent TURP after 2001. Patients undergoing TURP after 2001 were more likely to undergo new procedures within 5 years (15.4% vs. 10.3%, OR 1.49, 95% CI 1.29-1.73, p < 0.001) and be on BPH medications postoperatively (65% vs. 30%, p < 0.001). However, these post-2001 patients were also less likely to have incontinence (15.5% vs. 19.7%, OR 0.60, 95% CI 0.53-0.67, p < 0.001).

TURP prior to 2001 was associated with lower reoperation rate or continue medical therapy, however it was associated with higher rates of incontinence. Several potential explanations exist for these trends, and future studies are necessary to elucidate the reasons for them.