Mortality after surgery for benign prostate hyperplasia: a nationwide cohort study.

PURPOSE: To investigate postoperative mortality rates and risk factors for mortality after surgical treatment of benign prostate hyperplasia (BPH). METHODS: All patients who underwent partial prostate excision/resection from 2004 to 2014 in Finland were retrospectively assessed for eligibility using a nationwide registry. Procedures were classified as transurethral resection of the prostate (TURP), laser vaporization of the prostate (laser), and open prostatectomy. Univariable and multivariable regression were used to analyze the association of age, Charlson comorbidity index (CCI), operation type, annual center operation volume, study era, atrial fibrillation, and prostate cancer diagnosis with 90 days postoperative mortality. RESULTS: Among the 39,320 patients, TURP was the most common operation type for lower urinary tract symptoms in all age groups. The overall 90 days postoperative mortality was 1.10%. Excess mortality in the 90 days postoperative period was less than 0.5% in all age groups. Postoperative mortality after laser operations was 0.59% and 1.16% after TURP (p = 0.035). Older age, CCI score, and atrial fibrillation were identified as risk factors for postoperative mortality. Prostate cancer diagnosis and the center's annual operation volume were not significantly associated with mortality. The most common underlying causes of death were malignancy (35.5%) and cardiac disease (30.9%). CONCLUSION: Elective urologic procedures for BPH are generally considered safe, but mortality increases with age. Laser operations may be associated with lower mortality rates than the gold standard TURP. Thus, operative risks and benefits must be carefully considered on a case-by-case basis. Further studies comparing operation types are needed.

National trends of surgery for benign prostatic hyperplasia in Finland.

PURPOSE: To investigate national trends of surgical treatment for benign prostatic obstruction (BPO). METHODS: The Care Register for Healthcare in Finland was used to investigate the annual numbers and types of surgical procedures, operation incidence and duration of hospital stay between 2004 and 2018 in Finland. Procedures were classified using the Nordic Medico-Statistical Committee Classification of Surgical Procedures coding. Trends in incidence were analyzed with two-sided Cochran-Armitage test. Trends in duration of hospital stay and patient age were analyzed with linear regression. RESULTS: Transurethral resection of the prostate (TURP) was the most common operation type during the study period, covering over 70% of operations for BPO. Simultaneous with the implementation of photoselective vaporization of the prostate (PVP), the incidence of TURP, minimally invasive surgical therapies, transurethral vaporization of the prostate (TUVP) and open prostatectomies decreased (p < 0.05). The mean operation incidence rate in the population between 2004 and 2018 was 263 per 100,000. The duration of hospital stay shortened (p < 0.05), and the average age of operated patients increased by 2 years (p < 0.0001). CONCLUSION: The implementation of PVP did not challenge the dominating position of TURP in Finland, but it has probably influenced the overall use of other surgical therapies, excluding transurethral incision of the prostate.  The results might suggest that the conservative treatment is accentuated, patient selection is more thorough, and surgical intervention might be placed at a later stage of BPO.

Short- and long-term risks of photoselective laser vaporization of the prostate: a population-based comparison with transurethral resection of the prostate.

BACKGROUND: Transurethral resection of the prostate (TURP) is the standard surgical treatment for benign prostate enlargement (BPE). Photoselective vaporization of the prostate (PVP) is an alternative, but there is limited real-life evidence of PVP risks. OBJECTIVE: To compare short- and long-term risks of PVP to those of TURP in the treatment of BPE. MATERIALS AND METHODS: Consecutive patients who underwent elective PVP or TURP between 2006 and 2018 in 20 hospitals in Finland were retrospectively studied using a combination of national registries (n = 27,408; mean age 71 years). Short-term risks were postoperative mortality, major adverse cardiovascular events (MACE), and reoperations for bleeding. Long-term risks were reoperations for BPE or any urethral operations within 12 years. Differences between treatment groups were balanced by inverse probability of treatment weighting. Risks were analyzed using the Kaplan-Meier method and Cox regression. RESULTS: There were no differences in postoperative mortality or MACE between the study groups. Reoperations for bleeding were less frequent after PVP (0.9%, HR: 0.72, p = 0.042). Bleeding was more likely in patients with atrial fibrillation (number needed to treat [NNT] for PVP vs TURP: 61). Cumulative incidence for reoperation was higher after PVP (23.5%) than after TURP in long-term follow-up (17.8%; HR: 1.20, p < 0.0001, NNT: -31.7). CONCLUSIONS: PVP is associated with lower postoperative bleeding risk but higher long-term reoperation risk than TURP. Patients with high bleeding risk and a low likelihood of needing reoperation appear most suitable for laser vaporization.KEY MESSAGEPVP is associated with lower postoperative bleeding risk but higher long-term reoperation risk than TURP. PVP appears an attractive treatment option, especially for patients with high bleeding risk and a low likelihood of needing a reoperation.