Trends and Perioperative Outcomes of Surgical Treatments for Benign Prostatic Hyperplasia in Germany: Results from the GRAND Study.

Background and objective: Real-world data exploring the perioperative outcomes of different surgical treatments for benign prostatic hyperplasia (BPH) are lacking. We aimed to assess the trends of BPH surgeries and compare their perioperative outcomes.

Methods: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005-2022), and performed multiple patient-level analyses.

Key findings and limitations: Our study included 1 355 845 surgical treatments for BPH. Of these, 1 084 650 (79.9%) were transurethral resection of the prostate (TURP), 90 735 (6.9%) simple prostatectomy, 64 325 (4.7%) holmium laser enucleation of the prostate (HoLEP), 58 406 (4.3%) laser vaporization, 25 747 (1.9%) electrovaporization, 15 241 (1.1%) thulium laser enucleation of the prostate (ThuLEP), 7873 (0.58%) prostate incision, 3298 (0.24%) water ablation, 2724 (0.2%) water vapor thermal therapy, 1235 (0.09%) prostate stent, 1100 (0.08%) transurethral needle ablation of the prostate, and 511 (0.03%) prostatic urethral lift. The use of HoLEP, ThuLEP, water ablation, and water vapor thermal therapy has increased exponentially in the last years. After adjusting for the major risk factors in the multivariate regression analysis, simple prostatectomy was associated with the worst outcomes compared with TURP, followed by electrovaporization. On the contrary, HoLEP and ThuLEP were associated with favorable outcomes, in terms of sepsis, ureteral stent placement, transfusion, admission to the intensive care unit, hospital stay, and mortality, compared with TURP. Similarly, minimally invasive surgical therapies were associated with high safety compared with TURP. Nevertheless, our findings are based on retrospective billing data and are prone to a selection bias.

Conclusions and clinical implications: The trends and perioperative outcomes of BPH surgery should be taken into consideration to improve clinical decision-making and patient outcomes.