Current BPH practice patterns influenced by surgeon factors

A recent study analyzed the practice patterns of benign prostatic hyperplasia (BPH) procedures and found associations between surgeon factors and the utilization of certain surgical approaches to manage BPH.¹

The investigators of the study, which was published in Urology, retrospectively analyzed case log data ranging from 2008-2021 from the American Board of Urology (ABU), which resulted in data on 73,884 BPH surgeries logged among 6632 urologists. In total, the investigators, led by

Tenny Zhang, MD

Tenny Zhang, MD, of Weill Cornell Medicine Urology in New York, New York, examined 8 surgical procedures: simple prostatectomy, transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), transurethral incision of the prostate (TIUP), holmium laser enucleation of the prostate (HoLEP), prostatic urethral lift (PUL, UroLift), microwave ablation of the prostate, and radiofrequency ablation of the prostate. Each surgical modality was examined beginning at the start of the procedure’s Current Procedural Terminology (CPT) code. The CPT codes for HoLEP and PUL were both introduced at the start of or during the study period.

Data from the case logs showed that TURP was the most commonly performed BPH surgery in all but one year included in the study analysis. The utilization of TURP increased annually compared with other surgical methods (P = .010). Across the study period, 5677 (85.6%) of urologists performed 35,156 TURP surgeries, which made up 47.6% of all BPH surgeries analyzed.

For the remaining approaches, PVP represented 25.4% of total cases, PUL made up 10.7%, microwave ablation represented 5.5%, HoLEP made up 4.4%, radiofrequency ablation represented 3.3%, prostatectomy made up 2.4%, and TIUP represented less than 1%.

Along with TURP, PUL was the only other procedure included in the study to increase in usage over time. PUL usage increased significantly, with the utilization rates increasing from 1.6% of total BPH surgeries in 2015 to 32.5% in 2020 (P = .013).

When analyzing the usage of certain BPH surgical procedures among different urologists, the investigators also found that certain surgeon factors, such as surgeon age, patient age, and urologist subspecialization were associated with use of certain approaches.

TURP was more likely to be performed by male urologists (P = .011)and less likely to be performed by higher volume BPH surgeons and surgeons in the Mid-Atlantic (P = .006), New England (P = 0.035), and North Central (P = 0.041) regions. Patient age (P = .007) and case year (P = .010) were also associated with the usage of TURP.

HoLEP was more likely to be performed by urologists with a higher BPH surgical volume (P < .001) and with endourology subspecialization (P = .001). Surgeon age (P < .001) was also associated with the usage of HoLEP.

Numerous factors were associated with performing PUL, including high BPH volume (P < .001), subspecialization in andrology (P < .001), practice area population over 1 million (P = .045), and government practice (P = .001), private practice groups (P = .001), and salaried hospital practice (P = .049). A subspecialty in endourology was associated with significantly lower odds of performing PUL (P = .009).

Reference

1. Zhang TR, Thorogood SL, Sze C, et al. Current practice patterns in the surgical management of benign prostatic hyperplasia. Urology. Feb 28;S0090-4295(23)00191-7. doi:10.1016/j.urology.2023.02.025