Introduction & Objectives
TURP has been the cornerstone for treatment of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS) secondary to Benign Prostatic Obstruction (BPO) for decades. In recent years, new minimally invasive surgical treatments (MISTs), such as Water Vapour Therapy, Prostatic Urethral Lift or Transurethral Microwave Thermotherapy were introduced, which have different implications on surgical capacity. The study objective was to assess trends and variations in BPO surgical management in Belgium, England, France, Germany, Spain and Sweden in 2018-2022, and estimate the Covid-19 pandemic impact.
Materials & Methods
Publicly accessible data from national databases on BPO surgical procedure volumes, including outpatient and inpatient setting as well as length of stay (LOS), were obtained for six European countries for 2018-2022. Coding-based data was heterogenous in availability, structure, and reporting. Cross-country comparisons were enabled through re-categorisation, where possible. A General Linear Model alluded to statistical significance of pre- vs. post-pandemic surgical volumes.
Results
Cross-European analysis revealed great variations in BPO surgical care delivery regarding the development of procedure volumes, choice of treatment alternatives (Fig. 1), settings, and LOS. In 2020, BPO surgical volumes decreased in all countries, ranging -12.2% (Germany) to -45.2% (England) (p=0.031). A combined 38,824 fewer BPO surgeries were performed in 2020 vs. 2019, with another 12,709 fewer surgeries in 2021 vs. 2019. On average, 67% of BPO surgeries were TURP in 2022. Laser enucleation volumes steadily increased in Belgium, France and Germany. Adoption of MISTs was most advanced in England and Sweden, making up 12.5% and 23.5% of procedures in 2022. Day-case activity across BPO surgeries ranged 4.9% (France) to 28.7% (Sweden) in 2022. Average inpatient LOS also differed greatly, ranging 2.63 days (England) to 4.57 days (Germany) in 2022. Across countries, patients treated with MISTs vs. TURP more often had day-case procedures (80%-100% vs. 1%-12%) and shorter inpatient LOS (e.g. 1.79 vs. 2.19 in England in 2022).
Conclusions
TURP gradually declines, although remaining the most common procedure for BPO. Across six European countries, choice and uptake of surgical alternatives used to treat BPO vary greatly. With limited inpatient capacity and increasing demands on healthcare systems as invoked prominently during the pandemic, a shift towards surgical options offering day-case feasibility and reduced LOS is likely.
