Population based comparative effectiveness of transurethral resection of the prostate and laser therapy for benign prostatic hyperplasia

Abstract

Purpose: As the American population ages, benign prostatic hyperplasia and its associated lower urinary tract symptoms have become increasingly important causes of chronic morbidity. We assessed the comparative effectiveness of 2 common forms of surgical therapy, transurethral prostate resection and laser therapy, for benign prostatic hyperplasia.

Materials and methods: Using patient level discharge data and revisit files from the Agency for Healthcare Research and Quality we evaluated a cohort of patients who underwent transurethral prostate resection or laser therapy for benign prostatic hyperplasia in 2005 in California. Short-term outcomes, including in hospital complications, length of stay, 30-day rehospitalization, 30-day repeat surgery and 30-day emergency room visits, were compared between the therapies by regression analysis. Long-term re-treatment, defined as the absence of secondary procedures for benign prostatic hyperplasia or complications of therapy, was assessed by survival analysis. Analysis was adjusted for medical comorbidity, race, age and insurance status.

Results: Data on 11,645 hospital discharges showed that mean length of stay was shorter for laser therapy than for transurethral prostate resection (0.70 vs 2.03 days, p<0.0001). The 30-day repeat visit occurred in 16% of laser and 17.7% of resection cases (p=0.0338). The 4-year re-treatment rate was 8.3% for resection and 12.8% for laser therapy (p<0.0001). After adjustment patients with resection were 37% less likely to require repeat therapy than those with laser therapy (HR 0.64, p<0.0001).

Conclusions: Laser procedures and transurethral prostate resection provide effective management of benign prostatic hyperplasia/lower urinary tract symptoms. Laser procedures are associated with less need for hospitalization than transurethral prostate resection but appear to involve a trade-off in long-term efficacy.

Figure 1. Time to Surgical Retreatment among TURP and Laser Therapy Patients

TURP appeared to be more durable than laser therapy for treatment of BPH (median follow up of 4.49 years), with 91.7% (95% CI 91.06% to 92.23%) of TURP patients were free of repeat surgical therapy at 4 years after their initial BPH surgery compared to 87.2% (95% CI 86.01% to 88.42%) of laser therapy patients (p < 0.001).