Trends in the surgical treatment of benign prostatic hyperplasia in a tertiary hospital.
BACKGROUND
To assess current treatment trends and perioperative outcomes of transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP) in a tertiary institution.


METHODS
We prospectively collected a database of all patients undergoing TURP and PVP for benign prostatic hyperplasia (BPH) at a tertiary hospital between January 2011 and December 2013. Patient characteristics such as length of stay, readmission, anticoagulation status, American Society of Anesthesiologists (ASA) score and need for blood transfusion were recorded and analysed.


RESULTS
In total, 560 cases were included: 204 (36.4%) underwent TURP and 356 (63.6%) PVP. Patients undergoing PVP had higher ASA scores (P < 0.001) and were more frequently on continuing anticoagulant therapy (P < 0.001). With regards to non-aspirin/asasantin coagulation therapy, 61 (17.1%) patients underwent PVP with their anticoagulants continued while no patients who received TURP continued anticoagulation. Blood transfusion percentages were similar at 1.0% for TURP and 1.7% for PVP but readmission proportions were higher after PVP (32 patients, 9.0%) compared to TURP (10 patients, 4.9%). These differences were attenuated when excluding patients continuing anticoagulation during the procedure.


CONCLUSIONS
At our institution, the use of PVP has been increasing on a year-by-year basis. The results of the current study demonstrated that PVP is safe in patients with increased anaesthetic risk or on active anticoagulation when compared to traditional TURP. While this makes PVP an attractive alternative to TURP in high-risk anticoagulated patients, these patients may have complex post-discharge issues that should be addressed during the informed consent process.
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Darren
D
Ow
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Nathan
N
Papa
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Marlon
M
Perera
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Peter
P
Liodakis
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.|Olivia Newton-John for Cancer Research Institute, Heidelberg Branch, Austin Health, Melbourne, Victoria, Australia.
Shomik
S
Sengupta
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Stephen
S
Clarke
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.|Olivia Newton-John for Cancer Research Institute, Heidelberg Branch, Austin Health, Melbourne, Victoria, Australia.
Damien M
DM
Bolton
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.|Olivia Newton-John for Cancer Research Institute, Heidelberg Branch, Austin Health, Melbourne, Victoria, Australia.|Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Nathan
N
Lawrentschuk
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001803:Blood Transfusion; D006760:Hospitalization; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome
D000925:Anticoagulants
anticoagulant; benign prostatic hyperplasia; laser therapy; photovaporization; risk factor; urology