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Population-based assessment of re-treatment and healthcare utilisation after photoselective vaporization of the prostate or electrosurgical transurethral prostatectomy

Welk B, Reid J, Ordon M, Razvi H, Campbell J. BJU Int. 2019; Aug 7 [Epub ahead of print]. DOI: 10.1111/bju.14891.

Introduction — The real-world implementation and outcomes of laser-based transurethral resection of the prostate (TURP) have not been well studied. Our objective was to compare the healthcare utilization and repeat TURP rate among older men undergoing an electrosurgical TURP versus photoselective vaporization of the prostate (PVP).

Patients and Methods — We used administrative data from the province of Ontario, Canada to identify all men >66 years who underwent their first TURP/PVP between 2003-2016. Our primary exposure was type of procedure (PVP or electrosurgical TURP). Our primary outcome was need for repeat TURP/PVP. The primary analysis was an adjusted marginal Cox model approach, which accounted for clustering of patients within surgeons; adjusted hazard ratios (aHR) or odds ratios (aOR) and 95% confidence intervals are reported.

Results — We identified 52,748 men: 6,838 (13%) underwent PVP, and 45,910 (87%) underwent electrosurgical TURP. Median age was similar, and PVP became more common with time. Compared to the PVP group, more patients in the electrosurgical group had prior gross hematuria or urinary retention, and fewer had used anticoagulants, alpha blockers, or 5-alpha reductase inhibitors. The need for repeat TURP/PVP was significantly higher among men who had a PVP (aHR 1.57, CI 1.38-1.78, absolute risk difference +2.3%). PVP was also associated with a slightly higher risk of return to the emergency room within 30 days (aOR 1.11, CI 1.01-1.22) and a significantly lower risk of blood transfusion (aOR 0.24, CI 0.16-0.37); the majority of PVP cases were done as a <24hr stay (73%) versus electrosurgical TURP (7%).

Conclusions — While some of the expected benefits of PVP (such as reduced transfusion risk and shorter length of stay) were observed, the significantly higher rate of repeat surgical treatment compared to electrosurgical TURP may represent an important difference in implementation of this technology outside of clinical trials.