Presented by: Juan Sebastian Arroyave Villada B.S.
Icahn School of Medicine at Mount Sinai

Introduction

Transurethral resection of the prostate (TURP), laser procedures, and minimally invasive surgical techniques (MIST) are used for BPH management. Understanding utilization trends and outcomes for these procedures is crucial for tracking management preferences and improving patient outcomes.

Materials

We queried the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2004 to 2021. We used a combination of CPT, ICD9 and ICD10 codes to define categories of TURP, laser (coagulation, vaporization, enucleation), and MIST (microwave therapy, needle ablation, UroLift, nitinol implant, transurethral incision, stenting, Aquablation, Rezum, prostatic injections). We retrieved utilization frequencies and rates of complications (urethral stricture, urinary tract infection (UTI), hematuria, incontinence, and bladder neck contracture) for each procedure. Complication rates were compared between procedures using TURP as reference and odds-ratios were obtained.

Results

,

177,040 cases of BPH managed with the target procedures were identified: 93,157 (52.6%) TURP, 55,899 (31.6%) laser, and 27,984 (15.8%) MIST. Incidence of BPH increased from 2004 to 2021 (Figure 1). Utilization rates for TURP and laser procedures decreased and stayed the same, respectively, over this time period. MIST utilization increased, thereby capturing a greater proportion of total BPH cases (Figure 1).  Compared to laser, TURP was associated with higher odds of UTI (1.312, p< 0.01), bladder neck contracture (1.038, p=0.017), urethral stricture (1.226, p<0.01), and hematuria (1.182, p<0.01). Relative to MIST, TURP had higher odds of UTI (2.449, p<0.01), bladder neck contracture (2.042, p<0.01), and hematuria (1.882, p<0.01). Finally, TURP resulted in lower odds of incontinence and urethral stricture relative to MIST (0.782, p<0.01; 0.878, p<0.01).

Conclusion

TURP and Laser utilization have declined steadily from 2004-2021, but TURP continues to make up almost 50% of all BPH procedures in the modern treatment era. MIST procedures are gaining popularity and being utilized in a greater proportion of total BPH cases. Compared to TURP and Laser procedures, MIST is associated with lower rates of UTI, hematuria, and bladder neck contracture, but higher risk of urethral stricture and incontinence. 

Funding

None

Lead Authors

Daniel Wang, B.A.
Icahn School of Medicine at Mount Sinai

Co-Authors

Christopher Connors,
Icahn School of Medicine at Mount Sinai

Micah Levy,
Icahn School of Medicine at Mount Sinai

Khawaja Ali Bilal, BSc
Icahn School of Medicine at Mount Sinai

Khawaja Hasan Bilal, MD
Icahn School of Medicine at Mount Sinai

Osama Zaytoun, MD
Icahn School of Medicine at Mount Sinai

Francisca Larenas, MD
Icahn School of Medicine at Mount Sinai

Michael Palese, MD
Icahn School of Medicine at Mount Sinai