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UPJ INSIGHT National Trends in Surgical Management for Benign Prostatic Hyperplasia From 2013 to 2019
By: Jacob H. Feiertag, BS, Penn State College of Medicine, Hershey, Pennsylvania; Joseph Y. Clark, MD, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania | Posted on: 18 Mar 2024
Feiertag JH, Clark JY. National trends in surgical management for benign prostatic hyperplasia from 2013 to 2019 in the United States. Urol Pract. 2024;11(2):303-311.
Study Need and Importance
Benign prostatic hyperplasia (BPH) is a common pathology affecting lower urinary tract function of aging men. As an increasing number of BPH procedures emerge to alleviate lower urinary tract symptoms, understanding trends in BPH surgical management helps optimize patient care and treatment decisions. This study utilized the TriNetX database to investigate the evolving landscape of BPH surgeries in the United States from 2013 to 2019, exploring variations between the traditional gold standard transurethral resection of the prostate (TURP) and newer procedures, some of which are considered minimally invasive.
What We Found
There were over 300,000 BPH procedures recorded between 2013 and 2019. TURP was the most common procedure, constituting almost half of all interventions with a slight decrease from 2013 to 2019. Photoselective vaporization of the prostate was the second most common procedure. However, photoselective vaporization of the prostate demonstrated a notable decline from 31.8% in 2013 to 21.5% in 2019. Newer procedures such as prostatic urethral lift (UroLift), Rezu¯m, and holmium laser enucleation of the prostate exhibited increasing utilization, collectively rising from 3.8% in 2013 to 29.2% in 2019.
Limitations
The study utilized deidentified retrospective data, which restrict the analysis to broad performance indicators without more detailed patient characteristics (such as size of prostate, severity of symptoms, etc). Geographic diversity in the TriNetX database may not fully represent all BPH patients; thus, findings should be cross-referenced with other population-based studies evaluating BPH surgical treatment trends.
Interpretation for Patient Care
The persistence of TURP as the predominant BPH surgical method suggests its continued effectiveness and acceptance. However, the rising popularity of some of the newer, minimally invasive procedures demonstrates evolving patient and provider preferences. Urologists should consider factors such as procedure-specific risks, recovery times, and long-term outcomes when tailoring BPH management strategies. Shared decision-making between providers and patients is crucial considering the expanding array of treatment options.
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