Real-world data comparing minimally invasive surgeries for benign prostatic hyperplasia

Objectives: To assess the differences in surgical outcomes between the prostatic urethral lift (PUL) and previous thermal energy procedures for the treatment of benign prostatic hyperplasia (BPH). Methods: We present an observational population-based study of 2694 men with BPH in New York State and California who received PUL, transurethral needle ablation (TUNA), or transurethral microwave therapy (TUMT) in outpatient and ambulatory surgery settings from 2005 to 2018. For these surgical procedures, short-term outcomes were reported and compared using a Chi-square test and mixed-effect logistic regressions. Long-term outcomes were described using Kaplan–Meier failure curves and compared using a Log-rank test and Cox regressions. Results: A significant portion of PUL patients had a comorbidity count ≥ 2 (n = 838, 37.0%). PUL exhibited the lowest 30 day and 90-day inpatient or ER readmission rates among all surgical techniques except for 90-day ER readmission (p < 0.05). No differences were observed for 1- and 3-year risks of reoperation between PUL [5.5% (95% CI 4.4–6.8%) and 14.9% (95% CI 10.9–20.1%)], TUNA [7.4% (95% CI 5.0–10.9%) and 11.3% (95% CI 8.3–15.4%)] and TUMT [8.5% (95% CI 4.7–15.2%) and 15.3% (95% CI 9.5–24.0%)]. 1- and 3-year risks of stricture development for PUL were 0.2% (95% CI 0.0–0.7%) and 0.2% (95% CI 0.0–0.07%), respectively. Conclusion: In a patient population with chronic conditions, patients treated with PUL exhibited similar 30- and 90-day inpatient or ER readmission rates when compared to previous reports. However, 1- and 3-year reoperation risks for PUL closely resembled previous thermal energy surgical procedures.