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Trends in Surgical Management of Benign Prostatic Hyperplasia
Nora Lee1, Hui Xue2, Lori B. Lerner3
1Boston University Medical Center, Boston, MA;2Harvard University, Boston, MA;3Boston Veterans Affairs Hospital, Boston, MA

Surgical management of benign prostatic hyperplasia (BPH) has evolved, including techniques that can be used with the growing population of anticoagulated patients. We evaluated current trends in procedure utilization amongst American urologists.
A 90-item on-line survey was sent via email to: American Urological Association; Veterans Administration; Society for Government Service Urologists; Endourological Society. Data concerning utilization of 12 BPH surgical techniques were analyzed and compared to surgeons' demographics using categorical data analysis.
600 urologists replied; 570 currently perform BPH surgery. Table 1 shows procedure utilization. Urologists' age, year of residency completion, and region of country had no influence on technique utilization, except in Northeastern (less monopolar TURP, p=0.04) and New York Sections (less PVP, p=0.01). Academic versus private settings were no different other than RP and Button which occur more often in academics (RP 7% vs 2%, button TURP 28% vs 21%). High volume surgeons are more likely to perform monopolar and bipolar TURP, whereas low volume surgeons are more likely to perform PVP, HoLAP, and HoLEP.
Change in technology has altered urologists' surgical approach to BPH. OP and monopolar TURP are still the most utilized procedures, however, bipolar and laser therapies are becoming more common. Lower volume surgeons appear to perform more laser techniques. Academic programs did not influence preference in technique except with robotic surgery and Button.
Table 1.

Surgical techniquePercentage of respondents who utilize the procedure
Open prostatectomy78%
Monopolar transurethral resection of prostate (TURP)73%
Photoselective vaporization (PVP)58%
TURis button TURP24%
Bipolar TURP20%
Holmium laser ablation of prostate (HoLAP)18%
Holmium laser enucleation of prostate (HoLEP)8%
Diode laser vaporization8%
Thulium laser ablation of prostate4%
Robotic simple prostatectomy3%
Laparoscopic simple prostatectomy1%
Thulium laser enucleation of prostate0%

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