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Clinical Research

Morbidity and mortality after surgery for lower urinary tract symptoms: a study of 95 577 cases from a nationwide German health insurance database

Prostate Cancer and Prostatic Diseases volume 19, pages 406–411 (2016)Cite this article

Subjects

Abstract

Background:

Little real-world data is available on the comparison of different methods in surgery for lower urinary tract symptoms due to benign prostatic obstruction in terms of complications. The objective was to evaluate the proportions of TURP, open prostatectomy (OP) and laser-based surgical approaches over time and to analyse the effect of approach on complication rates.

Methods:

Using data of the German local healthcare funds (Allgemeine Ortskrankenkassen (AOK)), we identified 95 577 cases with a primary diagnosis of hyperplasia of prostate who received TURP, laser vaporisation (LVP), laser enucleation (LEP) of the prostate or OP between 2008 and 2013. Univariable logistic regression was used to analyse proportions of surgical approach over time, and the effect of surgical method on outcomes was analysed by means of multivariable logistic regression.

Results:

The proportion of TURP decreased from 83.4% in 2008 to 78.7% in 2013 (P<0.001). Relative to TURP and adjusting for age, co-morbidities, AOK hospital volume, year of surgery and antithrombotic medication, OP had increased mortality (odds ratio (OR) 1.47, P<0.05), transfusions (OR 5.20, P<0.001) and adverse events (OR 2.17, P<0.001), and lower re-interventions for bleeding (OR 0.75, P<0.001) and long-term re-interventions (OR 0.55, P<0.001). LVP carried a lower risk of transfusions (OR 0.57, P<0.001) and re-interventions for bleeding (OR 0.76, P<0.001), but a higher risk of long-term re-interventions (OR 1.43, P<0.001). LEP had increased re-interventions for bleeding (OR 1.35, P<0.01). Complications were also dependent on age and co-morbidity. Limitations include the lack of clinical information and functional results.

Conclusions:

OP has the greatest risks of complication despite a low re-intervention rate. LVP demonstrated favourable results for transfusion and bleeding, but increased long-term re-interventions compared with TURP, while LEP showed increased re-interventions for bleeding. Findings support a careful indication and choice of method for surgery for LUTS, taking age and co-morbidities into account.

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Acknowledgements

The work was performed at: Department of Urology, St Elisabeth-Hospital Straubing, Straubing, Germany Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany.

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Authors and Affiliations

  1. Department of Urology, St. Elisabeth Klinikum Straubing, Straubing, Germany

    C Gilfrich

  2. Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany

    H Leicht, E Jeschke & C Günster

  3. Federal Association of the Local Health Care Funds (AOK), Berlin, Germany

    C Fahlenbrach

  4. Department of Urology, Ernst von Bergmann Hospital, Potsdam, Germany

    G Popken

  5. Department of Urology, University of Leipzig, Leipzig, Germany

    J U Stolzenburg

  6. Foundation Men's Health (Stiftung Männergesundheit), Berlin, Germany

    L Weißbach

  7. Medical Review Board of the Social Health Insurance Funds, Hannover, Germany

    C Zastrow

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  1. C Gilfrich
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Correspondence to C Gilfrich.

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Gilfrich, C., Leicht, H., Fahlenbrach, C. et al. Morbidity and mortality after surgery for lower urinary tract symptoms: a study of 95 577 cases from a nationwide German health insurance database. Prostate Cancer Prostatic Dis 19, 406–411 (2016). https://doi.org/10.1038/pcan.2016.33

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  • DOI: https://doi.org/10.1038/pcan.2016.33

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