Safety and Efficacy of Outpatient Surgical Procedures for the Treatment of Benign Prostatic Enlargement in New York State and California (2005-2016).

PURPOSE: To compare outcomes of transurethral prostatectomy and laser prostatectomy in the real-world setting.

MATERIALS AND METHODS: We present a prospectively collected observational cohort study of 85,682 men with benign prostatic enlargement in New York State and California who received transurethral prostatectomy or laser prostatectomy in outpatient and ambulatory surgery settings from January 2005 to December 2016. We used propensity score matching to adjust for differences in patient characteristics between groups. We analyzed short-term outcomes using mixed-effect logistic regressions and long-term outcomes using Cox regressions with a time-dependent treatment variable to account for non-proportionality. We performed a sensitivity analysis using multivariable regression models.

RESULTS: Patients were aged 70.5±9.7 years (mean±SD), 71% were white race with a median follow-up period of 3.8 (interquartile range 1.8-6.3) years. Transurethral prostatectomy recipients had increased risk of 30-day hospital readmission/emergency room visit (odds ratio 1.09, 95% confidence interval 1.04-1.13, p <0.001) and decreased risk of reoperation (hazard ratio 0.81, 95% confidence interval 0.76-0.88, p <0.001). Transurethral prostatectomy had higher rate of urethral stricture (hazard ratio 1.47, 95% confidence interval 1.22-1.75, p <0.001).

CONCLUSIONS: Transurethral prostatectomy was associated with higher risk of short- and long-term complications, but a lower rate of long-term reoperation than laser prostatectomy for benign prostatic enlargement.