Laser prostatectomy use has increased substantially as a treatment for benign prostatic hyperplasia (BPH) at the expense of transurethral resection of the prostate (TURP), a study found.
Using the Florida State Inpatient Database and Ambulatory Surgery Database, Florian R. Schroeck, MD, and colleagues at the University of Michigan in Ann Arbor identified 54,399 TURP and 29,457 laser prostatectomy procedures that took place during the study period (2001 to 2009).
Although the overall rates of transurethral surgery for BPH remained stable during the study period at 248/100,000 men in 2001 and 233 per 100,000 men in 2009, laser prostatectomy use increased 400% from 25 to 114 procedures per 100,000 men during that same period, replacing about half of all TURPs, the researchers reported online in The Journal of Urology.
Older and sicker patients are less likely to undergo laser prostatectomy. Compared with patients aged 40-64, those aged 65-89 and 80 or older were 16% and 26% less likely to undergo laser prostatectomy after adjusting for year of treatment, race, socioeconomic status, surgeon volume, and type of primary payer. Compared with patients without comorbidities, those who had one and two or more comorbidities were, respectively, 21% and 52% less likely to undergo laser prostatectomy.
In addition, Dr. Schroeck’s team found that most of the variation in laser prostatectomy use was determined by the urologist seen by the patient, “implying that who the patient sees is a major determinant of which type of surgery is performed.”
“Given the potential advantages of laser prostatectomy, our results raise concern about possible underuse of this new technology among elderly and infirm patients,” the authors concluded.
Studies suggest that laser prostatectomy may be associated with shorter hospital stays and catheterization time, and a decreased risk of clot retention compared with TURP.
In a discussion of study limitations, the researchers noted that they were unable to elicit which type of laser or TURP equipment was used in a specific procedure. “Therefore, we cannot describe differential trends in the use of these laser procedures but it appears unlikely that the lack of these procedural details biased our results.”
The investigators also acknowledged that they did not have access to clinical information such as symptom severity or the amount of irritative symptoms. “Elderly patients may have had more irritative symptoms than younger patients,” Dr. Schroeck and his colleagues stated. “This could have dissuaded some physicians from offering laser prostatectomy, which has more irritative side effects than TURP postoperatively.”
The researchers explained that they chose Florida for their study because it is one of the larger and more ethnically diverse states participating in the Healthcare Cost and Utilization Project (HCUP), and the state captures discharges from various practice locations, including freestanding ambulatory surgery centers.
HCUP is sponsored by the federal Agency for Healthcare Research and Quality (AHRQ). Its databases bring together data collection efforts of state data organizations, the federal government, hospital associations, and private data organizations to create a national information resource of patient-level healthcare data, according to the AHRQ website.