Comparative effectiveness of transurethral resection techniques for benign prostatic hyperplasia - Analysis of an all payer in patient discharge database
Meyer C, Gild P, Von Landenberg N, Friedlander D, Eswara J, Menon M, Chun F, Fisch M, Sun M, Chung B, Chang S, and Trinh QD. Comparative effectiveness of transurethral resection techniques for benign prostatic hyperplasia - analysis of an all payer in patient discharge database. Eur Urol Supplements 2017; 16(3):e308-e309.
Eur Urol Supplements
INTRODUCTION & OBJECTIVES: Monopolar transurethral resection (mTURP) is the conventional surgical standard of care for bladder outlet obstruction (BOO) secondary to benign prostatic enlargement (BPH). Alternatively, holmium laser techniques, bipolar TURP (bTURP) and Greenlight photovaporization of the prostate (GL-PVP) constitute modern options with favorable safety profiles. However, current literature comparing various BOO treatment modalities is limited by sample size, study design, and the absence of cost data. We sought to compare costs and complication patterns of mTURP, bTURP and GL-PVP in a large, US all-payer discharge database. MATERIAL & METHODS: Using the Premier Research Database, we identified 20,323 men 40-80 years with a diagnosis of BPH who underwent a BOO procedure between 2003-2013. Using propensity weighted logistical regression, we assessed trends and perioperative outcomes of mTURP, bTURP, and GL-PVP. RESULTS: mTURP remained the most frequently performed procedure during the study period, but its utilization decreased by 20% during that time (p<0.001) (Figure 1). Whereas there were no significant differences between bTURP and mTURP with regards to OR time (p>0.99), LOS (p=0.82), and 90-day complication rates (p=0.34), GL-PVP was associated with longer OR times (+12 minutes, 95% CI: 10.25 to 13.75, p<0.001) but demonstrated a shorter LOS (OR: 0.51, 95% CI: 0.37 to 0.7, p<0.001) relative to mTURP. Both bTURP ($982, 95% CI: $509-1456, p<0.001) and GL-PVP ($1536, 95% CI: $1296-1775, p<0.001) were associated with higher 90-day direct hospital costs compared to mTURP. CONCLUSIONS: We show that the volume of inpatient endoscopic management of BPH has decreased significantly over the past decade. We found only a modest perioperative safety and outcome benefit with bTURP and GL-PVP over mTURP, while both procedures were associated with higher costs.