Login to Access Video or Poster Abstract: MP13-10
Sources of Funding: University of Toronto Functional Urology Research Group

Introduction

Benign prostatic obstruction (BPO) due to histologic benign prostatic hyperplasia is highly prevalent among older men. Despite widespread use of medical therapy, surgical treatment remains a mainstay in the management of BPO. We sought to characterise trends in the surgical management of BPO in a single-payer healthcare system in Ontario, Canada over a 20 year period.

Methods

We performed an interrupted time-series analysis using segmented regression among men aged 18 years and older undergoing surgical treatment for BPO between January 1, 1994 and December 31, 2014 in Ontario, Canada. The passage of time was considered the primary exposure. The primary outcome was the proportion of all BPO surgeries performed using each of the following modalities: transurethral resection of the prostate (TURP), endoscopic laser prostatectomy, open/laparoscopic prostatectomy, and others. Secondary outcomes included trends in the age and comorbidity of patients undergoing BPO surgery.

Results

We identified 136,459 men who underwent BPO surgery between 1994 and 2014. Across the study interval, the annual age-adjusted rate of BPO surgery declined significantly (24 per 10,000 population in 1995 to 10 per 10,000 population in 2014). We identified two distinct epochs with respect to treatment modality. From 1994 to 2001, there were no significant changes in the distribution of BPO surgical modalities with TURP the most common throughout (97.2% in 1994 and 97.0% in 2001). In the period 2002 to 2014, there was a significant decline in the use of TURP (92.1% to 76.9%; p=0.027) with a corresponding increase in the use of endoscopic laser prostatectomy (3.5% to 21.9%; p=0.0008). We identified small but statistically significant increases in the age (p=0.0004) and comorbidity (p<0.0001) of patients undergoing BPO surgery over time.

Conclusions

This large, population-based study demonstrates a shift in the management of BPO with increasing use of endoscopic laser prostatectomy, beginning in 2002. However, TURP remains the most common treatment modality. We also identified shifting demographics of patients undergoing BPO surgery with a trend for patients to be older and have greater comorbid disease at the time of surgery in more recent years.

Funding

University of Toronto Functional Urology Research Group