Surgical Re-intervention Rates After Invasive Treatment for Lower Urinary Tract Symptoms due to Benign Prostatic Syndrome: A Comparative Study of More than 43,000 Patients with Long-Term Follow-Up.

PURPOSE No large-scale comparison of the four most established surgical approaches for LUTS due to benign prostate obstruction in terms of long-term efficacy is available. We compared photoselective vaporisation, laser enucleation and open simple prostatectomy to transurethral resection with regard to 5-year surgical re-intervention rates. MATERIALS AND METHODS 43.041 male patients with LUTS who underwent transurethral resection (n=34,526), photoselective vaporisation (n=3,050), laser enucleation (n=1,814) or open simple prostatectomy (n=3,651) between 2011 and 2013 were identified in pseudonymised claims and core data of the German local health care funds (AOK) and followed for 5 years. Surgical re-interventions for LUTS, urethral stricture or bladder neck contracture were evaluated. Surgical approach was related to re-intervention risk using the Kaplan-Meier method and Cox proportional-hazards models. RESULTS ,050 first re-interventions occurred within 5 years of primary surgery (Kaplan-Meier survival without re-intervention: 87.5%, 95%-CI: 87.2%-87.8%). Photoselective vaporisation carried an increased hazard of re-intervention (HR 1.31, 95%-CI: 1.17-1.46, p <0.001) relative to transurethral resection, open simple prostatectomy carried a lower hazard (HR 0.43, 95%-CI: 0.37-0.50, p <0.001) and LEP did not differ significantly (HR 0.84, 95%-CI: 0.66-1.08, p=0.2). This pattern was more pronounced regarding re-intervention for LUTS recurrence (photoselective vaporisation: HR 1.52, 95%-CI: 1.35-1.72, p <0.001; LEP: HR 0.84, 95%-CI: 0.63-1.14, p=0.3; open simply prostatectomy: HR 0.38, 95%-CI: 0.31-0.46, p <0.001; relative to transurethral resection). CONCLUSIONS 5-year re-intervention rates of transurethral resection and laser enucleation did not differ significantly, while photoselective vaporisation had a substantially higher rate. Open simple prostatectomy remains superior to transurethral resection with respect to long-term efficacy.