Contemporary Trends of Holmium Laser Enucleation of the Prostate Utilization in the United States: A Comprehensive Analysis Using the National Surgical Quality Improvement Program Database (2011-2020)

Ahmad Abdelaziz; Mukund Bhandari; Ahmed Elshabrawy; Shaun Trecarten; Emad Eddin Dalla; Kamel A Samara; Fadi Alsayegh; Michael Liss; Ahmed M Mansour

doi:10.1089/end.2023.0612

Contemporary Trends of Holmium Laser Enucleation of the Prostate Utilization in the United States: A Comprehensive Analysis Using the National Surgical Quality Improvement Program Database (2011-2020)

J Endourol. 2024 May;38(5):521-528. doi: 10.1089/end.2023.0612.

Authors

Ahmad Abdelaziz¹, Mukund Bhandari², Ahmed Elshabrawy¹, Shaun Trecarten¹, Emad Eddin Dalla¹, Kamel A Samara¹, Fadi Alsayegh¹, Michael Liss¹, Ahmed M Mansour^{1

3}

Affiliations

¹ Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
² Department of Population Health Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
³ Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

PMID: 38299559
DOI: 10.1089/end.2023.0612

Abstract

Introduction: The most recent American Urological Association (AUA) Guidelines advocated laser enucleation of the prostate (LEP) as a size-independent surgical option for benign prostatic hyperplasia (BPH). Despite its endorsement by AUA and the growing body of evidence supporting its safety and efficacy, the utilization of LEP remains limited in the United States. This study aimed to evaluate the utilization trends and perioperative outcomes of LEP compared with other surgical procedures used for BPH management. Methods: A retrospective cohort analysis was performed using American College of Surgeons National Surgical Quality Improvement Program data from 2011 to 2020. Patients undergoing prostatectomy for BPH were identified using specific current procedural terminology (CPT) codes. Baseline demographic data, preoperative risk factors, and postoperative outcomes were collected. Multivariable logistic regression was employed to assess predictors of holmium laser enucleation of the prostate (HoLEP) utilization and postoperative complications. Results: Out of 8,415,549 patients, 95,144 underwent prostatectomy for BPH. Procedures included HoLEP 5305 cases, transurethral resection of the prostate (TURP) 57,803 cases, repeated TURP (re-TURP) 5549 cases, photoselective vaporization of the prostate (PVP) 23,739 cases, and simple prostatectomy 2748 cases. HoLEP utilization showed a gradual increase, from 4.8% in 2015 to 7.6% in 2020. Multivariable regression revealed that HoLEP selection significantly increased from 2016 to 2020 (odds ratio [OR]: 1.251, p < 0.001), and there was less likelihood of HoLEP selection for African American patients (OR: 0.752, p < 0.001). HoLEP had significantly lower complication rates, including urinary tract infections, blood transfusions, 30-day readmission, and reoperation. Conclusion: Despite underutilization, the adoption of HoLEP has slightly increased since 2015, rising from 4.8% in 2015 to 7.6% in 2020. The underutilization could be attributed to a lack of availability and the steep learning curve.

Keywords: BPH; HoLEP; trends.

MeSH terms

Aged
Databases, Factual
Humans
Laser Therapy / methods
Lasers, Solid-State* / therapeutic use
Male
Middle Aged
Postoperative Complications / epidemiology
Prostate / pathology
Prostate / surgery
Prostatectomy* / methods
Prostatic Hyperplasia* / surgery
Quality Improvement*
Retrospective Studies
United States