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Study: HoLEP use is on the rise for BPH


"Interestingly enough, we found that PVP accounted for nearly a third of BPH surgeries back in 2016. This number drastically decreased to just 0.7% of all BPH surgeries in 2019," says Jenny Guo, MD.

In this video, Jenny Guo, MD, discusses the background and notable findings from the Journal of Endourology paper, “Trends of Benign Prostatic Hyperplasia (BPH) procedures in Ambulatory Surgery Settings.” Guo is a urology resident at Northwestern University Feinberg School of Medicine in Chicago, Illinois.


Please describe the background for this study.

HoLEP is, as we know, a minimally invasive BPH surgery that's applicable for prostates of all sizes. It has notable advantages over some of the other BPH procedures out there. Specifically, when comparing HoLEP vs TURP, we've seen that HoLEP offers shorter catheter duration times as well as hospital length of stay. But despite a lot of these advantages, over the years, adoption of HoLEP in the US has been relatively low. That's been evidenced by medical care NSQIP data. There have been studies from 2011 to 2015 that have shown that HoLEP accounted for about 4% to 5% of all BPH surgeries during that time period. But in the past several years, there's been a lot of research and a lot of advances in laser technology that has allowed for more efficient hemostasis. And this has led to the advent of same-day discharge HoLEP and effectively has transformed the procedure into an outpatient ambulatory procedure. So in this study, we use a unique database called the NASS, which stands for the Nationwide Ambulatory Surgery Sample. This is the only nationwide all-payer database that accounts for about 76% of ambulatory surgery encounters. This database is unique in that it includes private insurers in addition to Medicare. And so using this database, we sought to evaluate BPH surgery uptake trends in 2016 compared to 2019.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

Some of the notable findings included that HoLEP was third in popularity back in 2016, accounting for 4.7% of ambulatory BPH surgeries. TURP was number 1 and PvP was number 2; however, HoLEP rose to second in popularity in 2019, up to 8.3% of all ambulatory BPH surgeries in that year, surpassing PVP. TURP remained the gold standard. On a regional basis, HoLEP was more popular in the Southern US, followed by the Midwestern region. Interestingly enough, we found that PVP accounted for nearly a third of BPH surgeries back in 2016. This number drastically decreased to just 0.7% of all BPH surgeries in 2019. We're not really sure why this is, but we hypothesized that it could have been because PVP has been shown to have additional side effects such as dysuria, and higher rates of reoperation compared to HoLEP, or to the gold standard TURP procedure. And in addition, because the tissue is vaporized, there is no way that it can be sent off for pathological analysis. For those reasons, TURP still remains the gold standard treatment in BPH.

This transcript was edited for clarity.

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