Transurethral resection of the prostate associated with lower risk of repeat procedures

Atlanta-Repeat surgery occurs two to three times as often after newer minimally invasive interventions for BPH compared with transurethral resection of the prostate (TURP), a review of Medicare claims data showed.

Overall, four different minimally invasive interventions had repeat surgery rates of about 20%. In contrast, repeat surgery occurred after 8.3% of TURP procedures. In most cases, TURP was the repeat procedure, even among patients who had TURP as the initial treatment, first author Sean Elliott, MD, reported at the AUA annual meeting in Atlanta.

"Even though TURP might be declining in frequency as the primary procedure for benign prostatic hyperplasia, it still seems to be the go-to procedure for primary treatment failure," Dr. Elliott, associate professor of urologic surgery at the University of Minnesota in Minneapolis, told Urology Times. "I think that probably emphasizes the fact that everyone, regardless of what they use as primary therapy, still recognizes TURP as the gold standard."

To examine the comparative long-term effectiveness of BPH procedures, Dr. Elliott and colleagues reviewed Medicare records to identify men who underwent BPH surgeries from 2001 through 2007. Using CPT codes, they identified 616,735 patients ages 66 years and older at the time of initial treatment. Duration of follow-up averaged 3.6 years.

TURP accounted for 51.8% of all the procedures, followed by TUMT (21.4%), laser vaporization (12.2%), laser coagulation (7.6%), and TUNA (7.0%). TURP's share of all procedures declined steadily over the study period, from 19.0% in 2001 to 9.2% in 2007. During the last year of the study period, laser vaporization was the most commonly performed BPH procedure (31.3%), followed by TUMT (17.1%), TUNA (15.2%), TURP, and laser coagulation (8.9%).

The primary outcome was repeat surgery. Investigators extended the review period to 2008 to capture repeat procedures. The secondary outcome was urologic complications associated with the BPH interventions.

Complications higher with TURP

The 5-year estimated incidence of repeat BPH surgery ranged from 8.3% with TURP to 25.8% after TUMT. After adjusting for patient and hospital factors, retreatment was 2.1 to 3.5 times more likely with laser vaporization or TUMT, respectively, than with TURP.

The most common postoperative complication was urethral stricture, occurring in 4.4% of patients overall, including 5.7% of TURP procedures, 2.3% of TUMT procedures, and 2.6% of TUNA procedures (p<.001).

Bladder-neck contraction occurred in 2.0% of patients overall, including 2.6% with TURP, 2.3% with laser coagulation, 1.6% with vaporization, and <1% with TUMT and TUNA (p<.001).

"It's nothing new to learn that the complication rate is higher with TURP, although not much higher than with the other two procedures," said Dr. Elliott. "On the other hand, the reoperation rate is dramatically lower with TURP."