LUTS outcomes vary across types of surgery

By Lorraine L Janeczko

NEW YORK (Reuters Health) - Morbidity and mortality after surgery for lower urinary tract symptoms (LUTS) vary depending on the type of surgery, a new study from Germany shows.

Open prostatectomy (OP) was associated with the greatest risk of complications, even though it also had a low reintervention rate. Laser vaporization of the prostate (LVP) showed favorable results for transfusion and bleeding, but increased long-term reinterventions, compared with transurethral resection of the prostate (TURP).

Laser enucleation of the prostate (LEP) was also associated with more reinterventions for bleeding than TURP, researchers report in Prostate Cancer and Prostatic Diseases, online August 9.

"This is an important study," said Dr. Ash Tewari, chair of urology at the Icahn School of Medicine at Mount Sinai Hospital in New York City, who was not involved in the research. "These findings provide clarity about complications and reintervention involving a common condition."

"Based on a patient's degree of obstruction, comorbidities and age, urologists should be able to select appropriate modalities ranging from the least invasive laser procedures to the most invasive open procedures," Dr. Tewari told Reuters Health by email.

For the study, Dr. Christian Gilfrich of Klinikum St. Elisabeth Straubing in Straubing, Germany, and colleagues reviewed data from a nationwide German health insurance database. They identified more than 95,000 cases with a primary diagnosis of prostatic hyperplasia who received TURP, LVP, LEP or OP between 2008 and 2013.

The proportion of TURP dropped from 83.4% in 2008 to 78.7% in 2013 (p

Also relative to TURP, LVP was tied to lower risk of transfusions (OR, 0.57; p

Dr. Sammy E. Elsamra, a urologic oncologist at the Rutgers Robert Wood Johnson Medical School in New Brunswick, said, "Many studies have compared only two modalities. Such studies often reflect experience at centers that are particularly proficient in one modality. This seems to be the only study to compare four separate treatment options for benign prostatic obstruction in such a large cohort of patients over such a long duration. Also, the broad-based approach for data collection helps eliminate some bias."

"Patients should generally assume both TURP and LVP are equivalent procedures and select the procedure their surgeon is most familiar and comfortable with," Dr. Elsamra, who was not involved in the research, told Reuters Health by email.

"Patients should generally undergo LEP or OP if their prostates are considered too large to treat with TURP or LVP, and they should understand that there is slightly higher risk of bleeding with these procedures," he added. "Also, other procedures not mentioned in this paper may need to be considered."

Dr. Jim C. Hu, a urologist and director of the Lefrak Center for Robotic Surgery at New York-Presbyterian/Weill Cornell Medical Center in New York City, said, "In the U.S., a robotic approach has supplanted the open approach. The advantage is lower blood loss compared to open as well as few complications with a low intervention rate. I think with longer followup, we'll see replacement of OP with robotic-assisted prostatectomy for larger prostates."

"Ultimately, for these relatively straightforward procedures, surgeon volume or experience rather than operative approach is the most important determinant of outcomes," Dr. Hu, who also was not involved in the study, told Reuters Health.

Dr. Gilfrich did not respond to requests for comment.

SOURCE: https://bit.ly/2cZXHJD

Prostate Cancer Prostatic Dis 2016.