Transurethral resection and other minimally invasive treatment options for BPH: would we treat ourselves as we treat our patients? Results from EAU Section of Uro-Technology (ESUT) decision-making survey among urologists

Abstract

Introduction: With the introduction of novel treatment options for benign prostatic hyperplasia (BPH), decision making regarding surgical management has become ever more complex. Factors such as clinical exposure, equipment availability, patient characteristics and hospital setting may affect what treatment is offered and an informed patient choice. The aim of this study was to investigate how urologists help patients make decisions regarding BPH management and whether their practice would differ if they were the patient themselves.

Material and methods: A 52-question survey presenting hypothetical clinical scenarios was distributed to European urologists and trainees/residents online and in person. In each scenario, regarding treatment options for BPH, the participant considered themselves firstly as the treating clinician and secondly as the patient themselves. Details regarding the participants' clinical experience, awareness of treatment options and exposure to these options were obtained.

Results: There were 139 participants; 69.8% of whom were consultants, with 82.1% of participants having practiced urology for more than 5 years. A total of 59.7% of urologists consider themselves BPH specialists. Furthermore, 93.5% of those surveyed had performed transurethral resection of the prostate (TURP), whilst procedures performed the least by participants were minimally invasive surgical therapy (MIST) options. Only 17.3% had seen and 1.4% had performed all of the treatment options. When considering themselves as a patient within standard practice, there was a preference for HoLEP amongst participants.

Conclusions: The majority of urologists surveyed had minimal experience to newer BPH techniques and MIST, suggesting that more exposure is required. A higher rate of HoLEP was chosen as a treatment option for urologists themselves as a patient than what they would choose as an option for their patients.

Keywords: TURP; benign prostatic hyperplasia; laser; lower urinary tract symptoms; rezum; urolift.

Figure 1

Investigations that participants would routinely organise for the hypothetical patient.

Figure 2

Q1 – participants standard BPH procedure. mTURP – monopolar transurethral resection of the prostate; bTURP – bipolar transurethral resection of the prostate; HoLEP – Holmium laser enucleation of the prostate; AEEP – other anatomical endoscopic enucleation of the prostate; Rezum – Rezum water therapy; PUL – prostatic urethral lift; PAE – prostatic artery embolization; GLL PVP – greenlight laser photoselective vapourisation of the prostate; iTIND – temporarily implanted nitinol device

Figure 3

Q2 – participants selection for prostate volume 30–80cc. mTURP – monopolar transurethral resection of the prostate; bTURP – bipolar transurethral resection of the prostate; HoLEP – Holmium laser enucleation of the prostate; AEEP – other anatomical endoscopic enucleation of the prostate; Rezum – Rezum water therapy; PUL – prostatic urethral lift; PAE – prostatic artery embolization; GLL PVP – greenlight laser photoselective vapourisation of the prostate; iTIND – temporarily implanted nitinol device

Figure 4

Q4 – participants selection if high PVR (>150 ml). mTURP – monopolar transurethral resection of the prostate; bTURP – bipolar transurethral resection of the prostate; HoLEP – Holmium laser enucleation of the prostate; AEEP – other anatomical endoscopic enucleation of the prostate; Rezum – Rezum water therapy; PUL – prostatic urethral lift; PAE – prostatic artery embolization; GLL PVP – greenlight laser photoselective vapourisation of the prostate; iTIND – temporarily implanted nitinol device

Figure 5

Q6 – participants selections if sexual function was not important. mTURP – monopolar transurethral resection of the prostate; bTURP – bipolar transurethral resection of the prostate; HoLEP – Holmium laser enucleation of the prostate; AEEP – other anatomical endoscopic enucleation of the prostate; Rezum – Rezum water therapy; PUL – prostatic urethral lift; PAE – prostatic artery embolization; GLL PVP – greenlight laser photoselective vapourisation of the prostate; iTIND – temporarily implanted nitinol device

Figure 6

Q12 – participant selection if patient took anticoagulation. mTURP – monopolar transurethral resection of the prostate; bTURP – bipolar transurethral resection of the prostate; HoLEP – Holmium laser enucleation of the prostate; AEEP – other anatomical endoscopic enucleation of the prostate; Rezum – Rezum water therapy; PUL – prostatic urethral lift; PAE – prostatic artery embolization; GLL PVP – greenlight laser photoselective vapourisation of the prostate; iTIND – temporarily implanted nitinol device

Figure 7

Q13 – participants selection if patient is not fit for anaesthesia. mTURP – monopolar transurethral resection of the prostate; bTURP – bipolar transurethral resection of the prostate; HoLEP – Holmium laser enucleation of the prostate; AEEP – other anatomical endoscopic enucleation of the prostate; Rezum – Rezum water therapy; PUL – prostatic urethral lift; PAE – prostatic artery embolization; GLL PVP – greenlight laser photoselective vapourisation of the prostate; iTIND – temporarily implanted nitinol device

Figure 8

Q15 – participants selection if patient does not have insurance and cannot afford to self-pay. mTURP – monopolar transurethral resection of the prostate; bTURP – bipolar transurethral resection of the prostate; HoLEP – Holmium laser enucleation of the prostate; AEEP – other anatomical endoscopic enucleation of the prostate; Rezum – Rezum water therapy; PUL – prostatic urethral lift; PAE – prostatic artery embolization; GLL PVP – greenlight laser photoselective vapourisation of the prostate; iTIND – temporarily implanted nitinol device

Figure 9

Q16 – participants selection if patient insured. mTURP – monopolar transurethral resection of the prostate; bTURP – bipolar transurethral resection of the prostate; HoLEP – Holmium laser enucleation of the prostate; AEEP – other anatomical endoscopic enucleation of the prostate; Rezum – Rezum water therapy; PUL – prostatic urethral lift; PAE – prostatic artery embolization; GLL PVP – greenlight laser photoselective vapourisation of the prostate; iTIND – temporarily implanted nitinol device