Case Western Reserve University School of Medicine
Introduction: Holmium laser enucleation of the prostate (HoLEP) was developed as a more efficient method of surgically managing benign prostatic hyperplasia (BPH) than the gold standard transurethral resection of the prostate (TURP). While institutional studies have demonstrated HoLEP to have comparable efficacy and reduced peri-operative morbidity compared to TURP, little is known of its adoption, safety, and efficacy in the community. We compare readmission and retreatment rates of HoLEP to other widely used endoscopic procedures for BPH including TURP, photoreceptive vaporization of the prostate (PVP), and Urolift. Methods: Men who underwent endoscopic treatments for BPH from 2000-2019 were identified in the service-level, hospital-based, all-payer claims Premier Healthcare Database (n=218,793). We compared the relative proportion of each procedure performed and annual physician volume data to identify trends in adoption and utilization. Readmission and retreatment rates were determined at both 30- and 90- days post-operation. Multivariable logistic regression was used to assess association between procedure type and outcomes. Results: HoLEP accounted for 3.2% (n=6,967) of all BPH procedures performed between 2000 and 2019 and increased from 1.1% of procedures in 2008 to 4% in 2019. From 2008-2019 the mean annual number of HoLEP cases per physician increased from 2.03 to 7.23. Patients receiving HoLEP demonstrated lower odds of 90-day readmission compared to TURP (OR 0.87, p=0.025). HoLEP demonstrated similar odds of retreatment compared to TURP at both 1-year (OR 0.96, p=0.7) and 2-years (OR 0.98, p=0.9), while patients undergoing PVP and Urolift were more likely to be retreated within 2-years (OR 1.20, p<0.001; OR 1.87, p<0.001). Conclusions: HoLEP remains a safe therapy for BPH with lower readmission and comparable retreatment rates to the gold standard TURP. Despite this, the adoption and utilization of HoLEP has lagged behind other endoscopic procedures like TURP, Urolift, and PVP over the past two decades. SOURCE OF Funding: N/A
