Use of minimally invasive BPH treatments up significantly

May 17, 2008

Use of minimally invasive surgical treatments (MISTs) for BPH has increased tremendously in the past decade, but urologists should be careful about overusing these newer technologies, given the lack of long-term evidence of their efficacy, researchers from the University of Minnesota said here.

Use of minimally invasive surgical treatments (MISTs) for BPH has increased tremendously in the past decade, but urologistsshould be careful about overusing these newer technologies, given the lack of long-term evidence of their efficacy,a urologist and health services research colleagues from the University of Minnesota said here.

Investigators reported a remarkable 529% increase in the number of MIST procedures performed from 1999 to 2005. Thisaccompanied a 44% increase in the overall number of BPH procedures and a 5% annual decrease in the rate of transurethralresections of the prostate.

Sean P. Elliott, MD, and colleagues identified BPH procedures from 100% Medicare fee-for-service carrier files from 1999through 2005. They reported that by 2005, MIST procedures comprised 57% of all BPH surgeries, while TURP was only 39%.

Office clinics were the setting for virtually all transurethral microwave therapy procedures, 86% of transurethral needleablations, and 54% of laser coagulations. Most laser vaporizations (78%) were carried out in hospital outpatientclinics.

Interestingly, the study found that African-Americans were 17% less likely than Caucasians to receive MIST procedures. In2006, the same University of Minnesota group published a paper showing that age-adjusted usage rates of TUMT and TUNA weretwice as high in Caucasians as in African-Americans (J Urol 2006; 175:1830-5).

The large percentage increase in MIST use came as a surprise, Dr. Elliott said. He and his colleagues anticipated highernumbers of MIST procedures, but not to the extent they found.

Dr. Elliott also noted the irony of shifting practice patterns for BPH. In the 1980s, he said, BPH was "primarily a surgicaldisease." With the introduction of alpha-antagonists, it became more of a medically treated affliction. Now, with the adventof MIST procedures, the pendulum is swinging back toward surgical therapies.