Presented by: Micah Levy
Icahn School of Medicine at Mount Sinai

Introduction

With improvements in the surgical management of benign prostatic hyperplasia (BPH) leading to increased indications and rising surgical rates, it is important to understand contemporary trends in reoperations in BPH surgical management.

Materials

The 2004 – 2021 New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for patients receiving BPH surgical management via transurethral resection of the prostate (TURP), laser therapies, prostatic ureteral lift (PUL), and other minimally invasive surgery therapies (MIST). Reoperation rates (RR) and the reoperation surgery method were analyzed between groups stratified by initial surgery method.

Results

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135,349 cases were analyzed (TURP: 58.97%, laser therapies: 34.94%, PUL: 4.44%, MIST: 1.66%). Across all cases the RR was 2.70%, 5.96%, 7.20%, 8.79%, and 9.21% for 1, 3, 5, 10, and 17 years following initial operation respectively, with 29.35%, 64.72%, 78.20%, and 95.47% of reoperations occurring within the first 1, 3, 5, and 10 years respectively. Laser therapies had the highest RR (10.34%), followed by MIST (9.85%), then TURP (8.81%) and finally PUL (5.28%), recognizing that the more recent PUL data has limited postoperative data to analyze and that laser therapies are a combination of several unique procedures. The laser therapy RR was significantly greater than that of TURP and PUL (p < 0.001) but not significantly different to that of MIST (p = 0.453), while the TURP RR was significantly greater than that of PUL (p < 0.001) but not that of MIST (p = 0.0872). TURP was the most common reoperation procedure making up 69.46% of all reoperations, suggesting patients are more likely to switch to TURP rather than to repeat the same initial surgery method. Despite this, rates of reoperations with laser, PUL, and MIST were higher when they were repeat procedures rather than a new surgery method (repeat laser: 41.10%, repeat PUL: 22.71%, repeat MIST: 14.03%), suggesting that patients are most likely to switch to a TURP or repeat the same surgery method as their initial procedure.

Conclusion

BPH reoperation rates reach up to 10% depending on the initial surgery type, with the highest rates amongst those initially treated with laser therapies. Though TURP remains the gold-standard, making up a large majority of reoperation surgeries, a significant proportion of patients choose to repeat the same surgery method for laser, PUL, and MIST reoperations

Funding

None

Co-Authors

Christopher Connors,
Icahn School of Medicine at Mount Sinai

Daniel Wang,
Icahn School of Medicine at Mount Sinai

Juan Arroyave Villada,
Icahn School of Medicine at Mount Sinai

Aaron Walt,
Icahn School of Medicine at Mount Sinai

Hasan Bilal,
Icahn School of Medicine at Mount Sinai

Francisca Larenas,
Icahn School of Medicine at Mount Sinai

Michael Palese,
Icahn School of Medicine at Mount Sinai