Compared with laser prostatectomy (LP) procedures, transurethral resection of the prostate (TURP) is generally associated with higher complication rates but lower reoperation rates in older men and men with multiple comorbidities, according to new study findings presented at the AUA2021 Virtual Experience.
Using the New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) and the California Office of Statewide Health Planning and Development 2005-2016 databases, investigators analyzed short- and long-term outcomes after TURP and LP in the populations typically underrepresented in trials: 29,806 patients aged 75 years and older and 12,815 patients with a Charlson Comorbidity Index (CCI) of 3 or greater. LP encompassed laser coagulation, vaporization, and enucleation of the prostate.
After propensity score matching, older men who underwent TURP vs LP had significant 7% increased adjusted odds for 90-day hospital readmission and emergency room visits, David Bouhadana, MD, of McGill University in Montreal, Quebec, Canada, and colleagues reported. Men with multiple comorbidities, conversely, had significant 8% decreased odds for these outcomes with TURP. Patients with more complex risk profiles may have opted for LP, the investigators suggested. They also noted that not all men with a CCI of 3 or greater are necessarily frail.
With respect to 90-day complications, older men who underwent TURP vs LP had significant 28% increased odds of hematuria. Their prostate volume and use of anticoagulants could not be assessed. The multimorbid group had significant 17% decreased odds of urinary tract infection following TURP.
TURP was associated with significant 20% and 19% lower adjusted odds of reoperation after 6 months compared with LP in the older and multimorbid populations, respectively. The investigators noted that less powerful lasers and a learning curve existed early in the study period. They also pointed out that the individual LP techniques — coagulation, enucleation, and vaporization — may yield different peri- and post-operative outcomes.
Men with multiple comorbidities had significant 53% increased adjusted odds of urethral stricture developing within 6 months of TURP.
“Clinicians often hesitate to perform TURP in the multimorbid and elderly population, as they may be more prone to perioperative complications,” Dr Bouhadana’s team wrote. “Compared to LP, TURP was associated with higher complication rates for the multi-morbid and elderly cohorts overall but a lower hazard of reoperation, supporting its durability.”
Bouhadana D, Nguyen DD, Elterman D, et al. Assessing the safety and efficacy of TURP vs laser prostatectomy for the treatment of benign prostatic hyperplasia in multimorbid and elderly individuals aged ≥75: an analysis of SPARCS. Presented at: AUA2021 Virtual Experience held September 10-13, 2021. Poster MP09-09.
Bouhadana D, Nguyen DD, Elterman D, et al. Safety and efficacy of TURP vs. laser prostatectomy for the treatment of benign prostatic hyperplasia in multi-morbid and elderly individuals aged ≥ 75. World J Urol. Published online July 7, 2021. doi:10.1007/s00345-021-03779-2