To compare postoperative outcomes of three types of endourologic surgeries (TURP, laser vaporization (LVP) and laser enucleation (LEP)) for BPH treatment using the ACS-NSQIP database.
The ACS-NSQIP database was queried for men who underwent TURP, PVP and LEP for treatment of BPH from 2011 till 2019.
Demographics, clinical, operative characteristics, and 30-day outcomes were compared. Univariate and multivariate regression models were constructed. Propensity score matching was then performed as a sensitivity analysis.
74,273 patients underwent endourologic surgeries for BPH, 65.4% had TURP, 28.6% PVP, and 5.9% LEP. Patients undergoing TURP were more likely to be older with higher ASA class, abnormal labs, and comorbidities (diabetic, congestive heart failure, and bleeding requiring transfusion) (p-value<0.001). After adjusting for covariates and propensity score matching, LVP demonstrated shorter hospital stays, shorter operative times, less reoperation rates, decreased DVT/PE risk, with however higher odds of urinary tract infection and sepsis as compared to TURP (p-value <0.028). Furthermore, LEP was found to have shorter hospital stays, longer operative times, and decreased odds of urinary tract infections and sepsis as compared to TURP (p-value <0.006).
LVP and LEP showed better surgical outcomes and characteristics as compared to TURP. Further research is needed to account for longer duration of follow-up and patient-specific urologic outcomes, such as prostate size, urinary incontinence, erectile dysfunction, and retrograde ejaculation.
Urology. 2023 May 12 [Epub ahead of print]
Christian Habib Ayoub, Rachelle Haber, Reem Amine, Diana Mikati, Ziyad Riyad Mahfoud, Albert El Hajj
Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: Christian.habib.ayoub1@gmail.com., Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: ree16@mail.aub.edu., Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: rha59@mail.aub.edu., Salim El-Hoss Bioethics & Professionalism Program, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: dm29@aub.edu.lb., Weill Cornell Medical College-Qatar, Doha, Qatar. Electronic address: zrm2001@qatar-med.cornell.edu., Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: ae67@aub.edu.lb.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37182649