Mount Sinai, New York, NY, USA.
Albany Medical College, Albany, NY, USA.
Prostate Cancer Prostatic Dis. 2024 Sep;27(3):485-491. doi: 10.1038/s41391-023-00741-8. Epub 2023 Oct 26.
Up to 50% of men over 50 and 80% over 80 are affected by BPH. Shared decision-making regarding BPH treatment options can benefit from an improved understanding of relative risks and benefits for various treatments.
Data for this longitudinal retrospective population-based cohort study were obtained from a random sample of US Medicare and commercial claims (IBM Watson MarketScan) and restricted to men undergoing BPH surgery (TURP, PVP, PUL, WVTT) from 2015 to 2021 across all sites of service. Retreatments included Holmium laser enucleation and index procedures. Main outcomes were rates of retreatment and procedural complications over 1 year, identified via CPT and ICD-9/10CM codes. Procedural complications that occurred at least 1 day post-index treatment were assessed, as were surgical retreatments with patients who had at least 1 and 5 year's-worth of data. Baseline phenotype characterization did not control for symptomatology and was limited to age, comorbidities, and BMI. Univariate cumulative incidence estimates, cumulative proportion and log-rank tests justified inclusion for covariate (e.g., age, comorbidities) adjustment in Cox proportional hazard models.
43,147 men diagnosed with BPH underwent 22,629 TURP, 11,392 PVP, 7,529 PUL, and 1,597 WVTT. At 1-year post-index: PUL was associated with the lowest rate of complication (PUL 15%, TURP 17%; PVP 19%, ; WVTT 26%); retreatment rates were not different (TURP 5.3%, PVP 5.3%, PUL 5.9%, WVTT 6.2%). At 5 years post-index: retreatment was lowest for TURP (7.0%) and was not significantly different between PVP and PUL (8.9% and 11.6%, respectively).
Real-world patients diagnosed with BPH may be selected to undergo one of the various available therapies based on patient preference or baseline phenotype. These therapies, however, are associated with different risks for complications. The results of this study suggest that within one year of BPH surgery, one-in-twenty patients may require retreatment regardless of treatment choice, and for some technologies as many as one-in-four may require treatment for a complication.
50%以上的 50 岁以上男性和 80%以上的 80 岁以上男性受到 BPH 的影响。BPH 治疗方案的共同决策可以通过更好地了解各种治疗方法的相对风险和益处来获益。
本纵向回顾性基于人群的队列研究的数据来自美国医疗保险和商业索赔（IBM Watson MarketScan）的随机样本，并仅限于 2015 年至 2021 年间在所有服务地点接受 BPH 手术（TURP、PVP、PUL、WVTT）的男性。Retreatments 包括钬激光前列腺剜除术和指数手术。主要结果是在 1 年内再次治疗和手术并发症的发生率，通过 CPT 和 ICD-9/10CM 代码识别。评估了索引治疗后至少 1 天发生的手术并发症，以及至少有 1 年和 5 年数据的患者的手术再治疗。基线表型特征未控制症状，仅限于年龄、合并症和 BMI。单变量累积发生率估计、累积比例和对数秩检验证明了 Cox 比例风险模型中协变量（如年龄、合并症）调整的纳入合理性。
43147 名诊断为 BPH 的男性接受了 22629 次 TURP、11392 次 PVP、7529 次 PUL 和 1597 次 WVTT。在索引后 1 年：PUL 与最低并发症率相关（PUL 15%，TURP 17%；PVP 19%，WVTT 26%）；再治疗率无差异（TURP 5.3%，PVP 5.3%，PUL 5.9%，WVTT 6.2%）。在索引后 5 年：TURP 的再治疗率最低（7.0%），PVP 和 PUL 之间没有显著差异（分别为 8.9%和 11.6%）。
被诊断为 BPH 的真实世界患者可能会根据患者的偏好或基线表型选择接受各种可用治疗方法之一。然而，这些治疗方法与并发症的风险不同。这项研究的结果表明，在 BPH 手术后一年内，每二十名患者中就有一名可能需要再次治疗，而无论治疗选择如何，对于某些技术，多达四分之一的患者可能需要治疗并发症。
