Elsevier

Urology

Volume 99, January 2017, Pages 186-191
Urology

Prostatic Diseases and Male Voiding Dysfunction
Impact of Minimally Invasive Benign Prostatic Hyperplasia Therapies on 30- and 90-Day Postoperative Office Encounters

https://doi.org/10.1016/j.urology.2016.10.015Get rights and content

Objective

To compare the frequency of postoperative encounters in the 30-day and 90-day postoperative periods for various bladder outlet obstruction surgical therapies.

Materials and Methods

All patients who underwent transurethral resection of the prostate (TURP), GreenLight laser photovaporization of the prostate (GL-PVP) (American Medical Systems Inc.), and holmium laser enucleation of the prostate (HoLEP) from January 1, 2012 to December 31, 2014 were followed for 6 months postoperatively. All postoperative encounters such as patient calls or questions, catheter exchanges or removals, and hospital-based readmissions or emergency department visits were recorded in the electronic medical record.

Results

Two hundred and ninety-one consecutive patients underwent outlet procedures during the study period: TURP (N = 199; mean age, 71 years; mean body mass index [BMI], 28.5), HoLEP (N = 60; mean age, 68 years; mean BMI, 28.1), or GL-PVP (N = 32; mean age, 72 years; mean BMI, 29.3). No statistically significant difference was observed for age, BMI, preoperative American Urological Association symptom score, or preoperative maximum flow velocity between the 3 groups. Thirty-day postoperative encounters differed significantly between the 3 surgery types (P < .001). Specifically, there were fewer encounters within 30 days of surgery for TURP compared to both HoLEP (≥1 encounter: TURP = 48.7%, HoLEP = 66.7%; P = .006) and GL-PVP (≥1 encounter: TURP = 48.7%, GL-PVP = 93.7%; P < .001). The number of encounters within 90 days postoperatively was also significantly lower for TURP patients (P < .001).

Conclusion

TURP results in fewer postoperative encounters in both the 30-day and 90-day postoperative periods compared to HoLEP and GL-PVP. Laser prostate therapies may place increased burden on clinic staff during the 30-day and 90-day postoperative periods.

Section snippets

Demographic Information

This study was approved by the Mayo Clinic Institutional Review Board. At our institution, 3 main surgical options (>30 cases/year) exist for BPH refractory to medical therapy: monopolar TURP, GL-PVP, and HoLEP. A total of 291 consecutive patients who underwent monopolar TURP (N = 199), HoLEP (N = 60), or GL-PVP (N = 32) for BPH at our institution between January 1, 2012 and December 31, 2014, were included in this retrospective study. All 6 surgeons performed TURP; however, a single surgeon

Demographic Information

A comparison of demographic, disease, and operative information between TURP patients, HoLEP/AP patients, and GL-PVP patients is shown in Table 1. Regarding demographic and disease information, characteristics were similar between the 3 surgery groups with the exception of preoperative PSA (P = .001), preoperative Qavg (P = .041), and preoperative PVR (P = .004). The differences in preoperative PSA between the 3 surgery groups are expected due to the nature of the surgeries, as larger glands

Discussion

The posthospital discharge period is subject to significant scrutiny, with aims to reduce rehospitalizations of paramount importance to the Centers of Medicare and Medicaid. Approximately 20% of the over 11 million Medicare beneficiaries reviewed from 2003 to 2004 were rehospitalized within 30 days of discharge.10 With respect to surgical diagnoses, 51.5% of patients who were discharged were rehospitalized or died within 1 year of discharge.10 Recognizing this flaw in healthcare delivery, the

Conclusion

Significant differences in postoperative encounters across 3 major BPH surgeries exist and transitioning to laser BPH therapies may place increased burden on clinic staff during both the 30-day and 90-day postoperative periods.

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Previous Presentation: Southeast Section AUA Podium Presentation, March 18, 2016, Nashville, TN.

Financial Disclosure: The authors declare that they have no relevant financial interests.

Funding Support: Mayo Clinic Institutional Grant.

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