Abstract
Purpose
To perform a global survey to identify contemporary practice patterns of transurethral therapies for benign prostatic hypertrophy.
Methods
A REDCap survey was distributed to the ~ 3500 members of the Endourological Society. Surgeons completed demographic information and then selected the BPH therapies they perform 10 cases/year. There were four categories of BPH therapies: ablation, enucleation, resection/vaporization, and MIST (minimally invasive surgical technique). Within each category, there were subcategories to account for different energy modalities. All statistical analyses were performed using SAS 9.4.
Results
A total of 175 surgeons responded to our survey. Prostate resection/vaporization remained the most commonly utilized technique (51.9%, n = 147/283) followed by enucleation (22.6%, n = 64/283). Bipolar TURP (bTURP) was the most common modality for prostate resection (69.4%, n = 102/147). Holmium laser enucleation (HoLEP) was the most common modality for enucleation (46.9%, n = 30/64). Urolift® was performed more often than Rezūm™ (55.9% vs. 44.1%, n = 19/34 vs. 15/34, respectively). Among surgeons performing ablation, country of practice was a significantly associated with length of stay (LOS), p < 0.0001. For surgeons performing enucleation, academic institution and completion of a fellowship were associated with postoperative day (POD) 1 catheter removal (p = 0.0240 and p = 0.020, respectively).
Conclusions
In this contemporary, global survey of the Endourology Society, resection/vaporization techniques were the most commonly performed. Rates of MISTs remained relatively low at 12.1%. Academic institution and fellowship status were associated with shorter catheterization times and LOS for certain surgical categories.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Parsons JK, Barry MJ, Dahm P (2019) Benign prostatic hyperplasia: surgical management of benign prostatic hyperplasia/lower urinary tract symptoms. AUA Guidelines
Smith RD, Patel A (2011) Transurethral resection of the prostate revisited and updated. Curr Opin Urol 21(1):36–41. https://doi.org/10.1097/MOU.0b013e3283411455
Das AK (2019) Techniques and innovative technologies for the treatment of BPH. Can J Urol 4(Suppl 1):1
Gravas S, Cornu JN, Gacci M (2020) EAU Guidelines on Management non-neurogenic male lower urinary tract symptoms (LUTS), including Benign prostatic obstruction (BPO). EAU Guidelines Office
Malaeb BSYX, McBean M, Elliot SP (2012) National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000–2008). Urology 79(5):1111–1117
Sosnowski R, De Nunzio C, Ahyai S et al (2015) Surgical management of benign prostatic obstruction: current practice patterns and attitudes in Europe. Neurourol Urodyn 34(4):395–396. https://doi.org/10.1002/nau.22727
Christidis D, McGrath S, Perera M, Manning T, Bolton D, Lawrentschuk N (2017) Minimally invasive surgical therapies for benign prostatic hypertrophy: the rise in minimally invasive surgical therapies. Prostate Int 5(2):41–46. https://doi.org/10.1016/j.prnil.2017.01.007
Bhojani N, Bidair M, Zorn KC et al (2019) Aquablation for benign prostatic hyperplasia in large prostates (80–150 cc): 1-year results. Urology 129:1–7. https://doi.org/10.1016/j.urology.2019.04.029
Gilling P, Barber N, Bidair M et al (2018) WATER: a double-blind, randomized, controlled trial of aquablation® vs transurethral resection of the prostate in benign prostatic hyperplasia. J Urol 199(5):1252–1261. https://doi.org/10.1016/j.juro.2017.12.065
McNicholas TA (2016) Benign prostatic hyperplasia and new treatment options—a critical appraisal of the UroLift system. Med Devices 9:115–123. https://doi.org/10.2147/MDER.S60780
Das AKLJ, Roehrborn CG (2019) Office-based therapies for benign prostatic hyperplasia: a review and update. Can J Urol 26(Supp 1):2–7
Roehrborn CBJ, Gange SN, Shore ND et al (2017) Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol 24(3):8802–8813
DA Kelly DC (2012) Holmium laser enucleation of the prostate technique for benign prostatic hyperplasia. Can J Urol 19(1):6131–6134
Raber M, Buchholz NNP, Vercesi A et al (2018) Thulium laser enucleation of the prostate (ThuLEP): results, complications, and risk factors in 139 consecutive cases. Arab J Urol 16(4):411–416. https://doi.org/10.1016/j.aju.2018.05.004
Enikeev D, Glybochko P, Rapoport L et al (2018) Impact of endoscopic enucleation of the prostate with thulium fiber laser on the erectile function. BMC Urol 8(1):87. https://doi.org/10.1186/s12894-018-0400-1
Regenbogen SE, Cain-Nielsen AH, Norton EC, Chen LM, Birkmeyer JD, Skinner JS (2017) Costs and consequences of early hospital discharge after major inpatient surgery in older adults. JAMA Surg 152(5):e170123. https://doi.org/10.1001/jamasurg.2017.0123
Magistro G, Weinhold P, Stief CG, Gratzke C (2018) The new kids on the block: prostatic urethral lift (Urolift) and convective water vapor energy ablation (Rezum). Curr Opin Urol 28(3):294–300. https://doi.org/10.1097/MOU.0000000000000502
Acknowledgements
We would like to extend a special thanks to Michele Paoli for her assistance with survey distribution to the Endourological Society.
Funding
None.
Author information
Authors and Affiliations
Contributions
MSL: project development, data collection, manuscript writing, and data analysis. MA: data collection and manuscript writing. DA: manuscript writing. TL: manuscript writing. AK: project development, manuscript writing, and data analysis.
Corresponding author
Ethics declarations
Conflict of interest
Dr. Amy Krambeck is a consultant for Ambu, Boston Scientific, Lumenis, and Virtuoso Surgical. She is a board member of Sonomotion.
Research involving human participants and/or animals
Not applicable.
Informed consent
Informed consent was not required as this study did not involve patients or any protected health information.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Lee, M.S., Assmus, M., Agarwal, D. et al. Contemporary practice patterns of transurethral therapies for benign prostate hypertrophy: results of a worldwide survey. World J Urol 39, 4207–4213 (2021). https://doi.org/10.1007/s00345-021-03760-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-021-03760-z