Large review: TURP still gold standard for BPH

Transurethral resection of the prostate (TURP) remains the gold standard for treating BPH, a review of Medicare claims data showed.

Encompassing outcomes with more than 600,000 procedures, the results showed that complications occur slightly more often with TURP, but approximately 20% of patients require follow-up surgery (usually TURP) after transurethral microwave therapy (TUMT), transurethral needle ablation (TUNA), laser vaporization, and laser coagulation.

"It’s nothing new to learn that the complication rate is higher with TURP, although not much higher than with the other procedures," said first author Sean Elliott, MD, of the University of Minnesota, Minneapolis. “On the other hand, the reoperation rate is dramatically lower with TURP.

"Even though TURP might be declining in frequency as the primary procedure, it still seems to be the go-to procedure for primary treatment failure," he added. "I think that probably emphasizes the fact that everyone, regardless of what they use as primary therapy, still recognizes TURP as the gold standard."

To examine the comparative effectiveness of procedures for BPH, the authors reviewed 100% Medicare files for the years 2001 through 2007, identifying 624,319 men who had TURP, TUNA, TUMT, or one of the laser procedures. TURP accounted for 52.3% of all the procedures, and follow-up averaged 3.6 years.

The most common postoperative complication was urethral stricture, occurring in 4.4% of patients overall, including 5.7% of TURP procedures, 2.3% of TUMT procedures, and 2.6% of TUNA procedures (pp

The 5-year estimated incidence of repeat BPH surgery ranged from 8.3% with TURP to 25.8% after TUMT. After adjusting for patient and hospital factors, retreatment was 2.1 to 3.5 times more likely with laser vaporization or TUMT, respectively, than with TURP.

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