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EAU 2018: Reoperation Rates And Mortality After Transurethral And Open Prostatectomy In A Long-term Nation-wide Analysis: Have We Improved Over A Decade?

Copenhagen, Denmark (UroToday.com) Benign prostatic hyperplasia (BPH) is of significant impact to the patients’ quality of life and is often the primary contributor to lower urinary tract symptoms (LUTS). According to AUA and EAU guidelines, transurethral resection of the prostate remains the gold standard of treatment for LUTS due to BPH. However, patients often avoid this procedure to its invasive nature and risk of side effects such as erectile dysfunction. More recently, the advent of robotic and laparoscopic surgeries have facilitated the rise of minimally invasive treatments such as that of the simple prostatectomy.

Dr. Eredics (MD) from the Department of Urology at Kaiser Franz Josef Hospital in Vienna, Austria presents a retrospective analysis of 21,674 who underwent TURP or open prostatectomy for the treatment of LUTS-related BPH. The primary outcome measure was the cumulative incidence of reoperation and the secondary outcome measure was mortality through the follow-up periods (1, 5, and 8 years). A historic control group from 1992-1996 was used as comparison.

Overall, 20,388 men underwent TURP and 1,286 underwent open prostatectomy between 2002 and 2009. Reoperation after primary TURP at 1 year, 5 years, and 8 years, was 2.4%, 6.1% and 8.3%, respectively. In comparison, reoperation after primary prostatectomy at 1, 5, and 8 years was 1.8%, 3.7%, and 4.3%, respectively. When compared to the 1992-1996 cohort, re-intervention rates did not improve.

Since 1992, Austrian TURP rates have remained fairly stable between 1992 and 2006. However, there was a 50% decline of open prostatectomy, which the authors purport to be likely due to the advent of new minimally invasive surgical techniques and treatment methods for BPH-related LUTS.

In discussion, Dr. Eredics also noted that mortality rates in the past decade have declined by 20% despite the fact that re-intervention rates have remained unchanged. Future studies assessing the efficacy and treatment benefits of minimally invasive technologies were recommended by the primary investigators, especially in comparison to these two cohorts of patients.

Authors: Klaus Eredics, David Wachabauer, Florian Rothlin, Stephan Madersbacher, Ingrid Schauer

Written by: Linda M. Huynh, B.S., University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark