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Early Patient-Reported Outcomes Following Contemporary BPH Procedures: A Prospective Multicenter Comparison of TURP, HoLEP, Aquablation, and PAE
Ra'ad Al-Faouri, MD MMSc, Thaise Uzeda, MD, Andrew Williams, MD, Jaleta Ahmed, MS, Christian Schaufler, MD, Michelle Shabo, MD, Shaun Wason, MD, Ruslan Korets, MD, Heidi J. Rayala, MD/PHD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
BACKGROUND: Benign prostatic hyperplasia affects millions of men and represents a significant healthcare burden. While transurethral resection of the prostate (TURP) remains the most commonly performed BPH surgery in the US, the therapeutic landscape has expanded to include holmium laser enucleation of the prostate (HoLEP), Aquablation, and prostatic artery embolization (PAE). Patient-reported functional outcomes comparing modalities remains limited.
METHODS: This multi-center, prospective study enrolled patients undergoing procedural BPH treatments. Demographic and clinical data were collected. Validated patient-reported outcomes were assessed preprocedurally, at 2 weeks and 1 month postprocedurally. Primary outcomes included International Prostate Symptom Score (IPSS), Quality of Life (QoL), International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form (ICIQ-UI SF),and dysuria measured on 0-10 numeric rating scale (NRS). Changes over time and differences between procedures were analyzed using mixed-effects linear regression models to account for repeated measures.
RESULTS: In interim analysis, 99 patients had been enrolled, with continued accrual ongoing. IPSS scores across all procedures improved significantly at both two weeks (p=0.005) and 1 month (p<0.001), though PAE had a more delayed response. QoL also improved significantly at 2 weeks (p=0.028) and 1 month (p=0.003). ICIQ-UI SF increased at two weeks and decreased at 1 month across all procedures except HoLEP. Dysuria increased at 2 weeks and decreased at 1 month across all procedures, thought results were not statistically significant. No significant time-by-procedure interaction was observed for any outcome, indicating similar trajectories.
CONCLUSIONS: In this prospective cohort, TURP, HoLEP, Aquablation, and PAE all demonstrated significant improvements in IPSS and QoL at two weeks and one month. While PAE showed slower early response, short-term functional outcomes were similar across treatments, suggesting similar early recovery profiles.
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