Evolution of the Endoscopic Surgical Approach for Benign Prostatic Obstruction in European Countries

Abstract

Background and objective: The endoscopic surgical approach for treatment of benign prostatic obstruction (BPO) has evolved over time and differs across European countries. We report on variations and trends in Belgium, England, France, Germany, Spain, and Sweden between 2018 and 2023.

Methods: Publicly accessible procedure data were used, including procedural volumes, hospital length of stay (LOS), and the proportion of daycase procedures, where available. Procedure codes were categorised to allow cross-country comparison, where appropriate. General linear model and Poisson regression analyses were conducted to assess the statistical significance of differences in volumes, daycase rates, and LOS across procedure categories and countries over time.

Key findings and limitations: Data for 1 100 365 endoscopic surgical BPO procedures between 2018 and 2023 were included in the analysis. Surgical volumes, treatment choice, LOS, and daycase rates varied greatly across the six countries. From 2019 to 2023, the relative proportion of transurethral resection of the prostate (TURP) cases declined from 74% to 64.5% in countries with distinct codes for this procedure, while laser treatment and minimally invasive surgical treatment (MIST) cases increased by 8.2% and 1.11%, respectively, on average. LOS was significantly shorter after MIST than after TURP procedures (p < 0.001). The daycase rate was significantly higher for MIST and laser procedures in comparison to TURP (p < 0.001). Procedure code-based data were heterogeneous in terms of their availability, structure, and reporting.

Conclusions and clinical implications: European treatment choices for lower urinary tract symptoms secondary to BPO have evolved towards increasingly diversified endoscopic surgical options, including laser and MIST procedures alongside TURP. Data on LOS and daycase activity illustrate that laser and MIST procedures have a low impact on capacity in comparison to TURP. This may help in alleviating hospital capacity constraints, improving resource allocation, and reducing surgical waiting lists.

Keywords: Benign prostatic hyperplasia; Benign prostatic obstruction; Laser enucleation of the prostate; Lower urinary tract symptoms; Minimally invasive surgical treatment; Real-world evidence.