Surgical management of benign prostatic obstruction: 20-year population-level trends

Authors

  • Joseph R. LaBossiere Division of Urology, Department of Surgery, Northern Alberta Urology Institute, University of Alberta, Alberta, Canada
  • Christopher J.D. Wallis Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
  • Sender Herschorn Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
  • Lesley Carr
  • Refik Saskin Institute of Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada
  • Robert Nam Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada

DOI:

https://doi.org/10.5489/cuaj.6224

Keywords:

Benign Prostatic Enlargement, TURP, Endoscopic Laser Prostatectomy

Abstract

Introduction: Benign prostatic obstruction (BPO) due to histological benign prostatic hyperplasia is highly prevalent among older men. Despite widespread use of medical therapy, surgical treatment remains a mainstay in the management of BPO. We sought to characterize trends in the surgical management of BPO in Ontario, Canada.

Methods: We performed an interrupted time-series analysis using segmented regression among men aged 18 years and older undergoing surgical treatment for BPO between January 1, 1994 and December 31, 2014 in Ontario, Canada. The passage of time was considered the primary exposure. The primary outcome was the proportion of all BPO surgeries performed using each of the following modalities: transurethral resection of the prostate (TURP), endoscopic laser prostatectomy, open/laparoscopic prostatectomy, and others.

Results: We identified 136 459 men who underwent BPO surgery between 1994 and 2014. The annual age-adjusted rate of BPO surgery declined significantly over time (24 to 10 per 10 000 population in 1994 and 2014, respectively). From 1994–2001, there were no significant changes in the distribution of BPO surgical modalities, with TURP the most common throughout (97.2% and 97% in 1994 and 2001, respectively). From 2002–2014, there was a significant decline in the use of TURP (92.1% to 76.9%; p=0.027) with a corresponding increase in the use of endoscopic laser prostatectomy (3.5% to 21.9%; p=0.0008).

Conclusions: This study demonstrates a shift in the management of BPO, with increasing use of endoscopic laser prostatectomy, beginning in 2002. However, TURP remains the most common treatment modality.

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Author Biographies

Joseph R. LaBossiere, Division of Urology, Department of Surgery, Northern Alberta Urology Institute, University of Alberta, Alberta, Canada

Assistant Professor of Surgery

Affiliation

Division of Urology, Department of Surgery, Northern Alberta Urology Institute, University of Alberta, Alberta, Canada

Christopher J.D. Wallis, Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada

Urology resident

Affiliations:

Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada

Institute of Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada

Sender Herschorn, Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada

Professor of Surgery

Affiliations:

Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada

 

Refik Saskin, Institute of Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada

Adjunct Professor

Affiliation:

Institute of Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada

Institute of Clinical Evaluative Sciences, Sunnybrook Research Institute, University of Toronto, Ontario, Canada

Robert Nam, Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada

Professor of Surgery

Affiliations:

Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada

Institute of Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada

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Published

2020-03-23

How to Cite

LaBossiere, J., Wallis, C. ., Herschorn, S. ., Carr, L., Saskin, R., & Nam, R. (2020). Surgical management of benign prostatic obstruction: 20-year population-level trends. Canadian Urological Association Journal, 14(8), 252–7. https://doi.org/10.5489/cuaj.6224

Issue

Vol. 14 No. 8 (2020): CUAJ August

Section

Original Research

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