Shifts in clinical practice and patient demographics following the introduction of holmium laser enucleation for benign prostatic hyperplasia in a general urology clinic.

Abstract

Background: Holmium laser enucleation of the prostate (HoLEP) has emerged as an effective surgical treatment for benign prostatic hyperplasia (BPH). This study evaluated how the adoption of HoLEP in a general urology clinic influenced clinical and procedural volume.

Objective: To better understand the practice ramifications of HoLEP adoption, we analyzed the changes to a general urologist's patient demographics and practice patterns after the addition of HoLEP to their surgical repertoire.

Methods: We retrospectively reviewed the electronic health records 30 months before and after the introduction of HoLEP to examine changes in a general urologist's patient population. Pearson's Chi-squared test and Student's t-test were used for statistical analysis.

Results: A total of 4390 unique patients were seen over a period of 5-years, with 2052 seen before and 2338 after the introduction of HoLEP. The mean distance from patients' residence zip codes to the treatment center remained statistically unchanged (pre-HoLEP: 32.52 ± 152.42 miles, post-HoLEP: 29.65 ± 141.79 miles, p=0.9896). Among those who underwent HoLEP, prostate sizes were comparable between patients residing in the same county and those coming from different counties (96.42 ± 3.24 cc vs. 104.52 ± 4.34 cc, p=0.141). Surgical volume rose from 355 to 1018 cases with a concordant increase in other BPH-related surgeries, marked by an inflection point at the time of HoLEP's introduction.

Conclusion: There was an increase in clinical and surgical volume to an established general urologist's practice after HoLEP was offered. Most patients continued to be drawn from the initial catchment area, potentially reflecting previously unmet treatment needs for patients with large prostate glands.