A large real-world analysis of retreatment and return procedures found that the prostatic urethral lift (PUL, UroLift) has the lowest complications, and that Rezum has the highest retreatment rate, when comparing these procedures along with GreenLight and transurethral resection of the prostate (TURP).1
The results were presented at the 2021 American Urological Association Annual Meeting by Steven A. Kaplan, MD, professor of urology and director of the Men's Wellness Program, Mount Sinai Health System and Professor, Icahn School of Medicine at Mount Sinai, New York.
Kaplan and co-investigator Daniel Rukstalis, MD, sought to compare real-world rates and calculated hazards for surgical retreatment and return procedures following treatment with minimally invasive surgical treatments or traditional surgery. Real-world data were derived from a patient-level longitudinal, observational analysis of Medicare and commercial outcomes claims data from 2015-2019. Multivariate Cox proportional hazard models were used for calculating hazard ratios for encountering a surgical retreatment or a post-operative return procedure, accounting for potential differences in treatment populations. A return procedure was defined as a postoperative procedure performed during a return visit to an outpatient setting as identified by a CPT or ICD-9 or -10 code. Surgical retreatment was defined as a second BPH procedure (Rezum, GreenLight, transurethral resection of the prostate [TURP], PUL, or holmium laser enucleation of the prostate).
Of the men included in the study, 19,507 underwent TURP, 10,173 underwent GreenLight, 5228 underwent PUL, and 935 underwent Rezum.
“At 365 days, the rate of return procedures was lowest for the UroLift. The rate of return procedures was higher after Rezum versus UroLift,” Kaplan said. Specifically, the rates of return for the 4 procedures were 23% for Rezum, 22% for GreenLight, 21% for TURP, and 17% for PUL.
Looking at the hazard model for return procedures and after adjusting for population variables, the investigators found a lower risk of experiencing a return procedure after PUL vs GreenLight, Rezum, and TURP. There was a 24% higher hazard for TURP vs PUL, 35% higher hazard for GreenLight vs PUL, and 41% higher hazard for Rezum vs PUL.
In addition, at 1 year, the rate of surgical retreatment was similar between GreenLight, TURP, and PUL, but was higher for Rezum vs PUL (P = .04). Rates of retreatment at 1 year were 7.2% for Rezum, 5.2% for GreenLight, 5.3% for TURP, and 5.4% for PUL.
Looking at the hazard model for retreatment, risk of retreatment within 1 year was similar for GreenLight, TURP, and PUL, the highest risk for retreatment being seen with Rezum. There was a 36% higher hazard for Rezum vs PUL, 40% higher hazard for Rezum vs TURP, and 43% higher hazard for Rezum vs GreenLight.
“After adjusting for variables such as age, comorbidity, site of service, the hazard modeling indicated that the risk of return procedures and retreatment after Rezum was higher than after UroLift. The data from this large-scale, real-world analysis can be utilized to aid patients and providers—and, I would say, payers—in making informed treatment decisions,” Kaplan said.
1. Kaplan S, Rukstalis D. UroLift PUL compared to Rezum, TURP and Greenlight PVP: US Medicare and commercial claims analysis reveals lowest complications for PUL and highest retreatment for Rezum. Paper presented at 2021 American Urological Association Annual Meeting; September 10-13; virtual. Abstract LBA01-01