The 21st Century Marks a Rise in TURP Retreatment Rates: An Analysis of Veterans Health Administration Data - Expert Commentary
This question was explored by a group primarily from the University of California, San Diego, and was recently published in the World Journal of Urology. Using the Veterans Affairs national repository of electronic medical data, men who underwent TURP prior to 2001(1996-2000) and afterwards (2001-2024) were assessed with respect to the requirement to undergo a new procedure for the same condition within 5 years, the likelihood that they still required BPH medications, and the likelihood of urinary incontinence. The population from the older era was much smaller, but still substantial (2084 patients vs. 35907). As a group they were healthier and less obese, with a higher proportion of Charlson comorbidity index(CCI) of 0(44.8% vs. 31.8%) and a lower proportion of BMI over 30(17.9 vs. 24.1%), but a lower proportion on pre-operative BPH medication (25 vs. 75%), a lower percent in urinary retention prior to surgery(36.3 vs. 41.1%), and a lower preoperative incontinence rate(all types), 5.6 vs. 10.7%). Postoperatively, patients in the earlier era group had a lower rate of reoperation (10.3 vs. 15.4%), a higher rate of all types of incontinence (19.7 vs. 15.5%), but a similar rate of stress incontinence (2.2 vs. 2.8%), and were less likely to have been started on medications for BPH (30 vs. 65%). In a multivariable logistic regression analysis that adjusted for age, preoperative retention status, prior urethral stricture or incontinence, race/ethnicity, CCI, and BMI over 30, patients undergoing TURP after 2001 were more likely to require another BPH procedure within 5 years (OR 1.49), with older age, preoperative retention, and CCI over 2 identified as associated factors. They were less likely to have urinary incontinence of all types (OR 0.60).
So, does the increased retreatment rate in the post 2000 group mean that the later trained practitioners were not as well exposed to TURP in their training? Or, that the technique had somehow changed? Perhaps they did not have the quantity of specific experience with TURP because of the many competing modalities that have appeared on the scene. Why, then, was their total incontinence rate lower? Were the figures consistent from VA to VA, and are they different from unbiased reports from practice groups? It is unfortunate that we do not have any data regarding prostate size, either preoperative or grams resected, absolute indications for outlet reduction or preoperative evaluation. A higher percentage of the post 2000 population was in urinary retention, and a much larger percentage had been on BPH medication, perhaps indicating that the operating physicians had been a bit more patient, rightly or wrongly, in waiting to recommend surgery. Are these data perfect? No, but the authors should be congratulated on a unique set of results that, at the very least, gives us useful information to transmit to patients about what is still considered the “gold standard” procedure for bladder outlet reduction for BPH regarding the contemporary likelihood of requiring additional surgical or medical treatment within 5 years.
Written by: Alan Wein, MD, PhD, FACS, Professor of Clinical Urology, Department of Urology, Desai Sethi Urology Institute (DSUI), University of Miami Miller School of Medicine, University of Miami Health Systems, Miami, FL
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