Patients who underwent holmium laser enucleation as a surgical treatment for benign prostate hyperplasia (BPH) had greater satisfaction and better quality of life outcomes, according to a recent study entitled, “Analysis of Benign Prostatic Hyperplasia Patients’ Perspective Through a Third Party–Administered Survey,” published in the Urology journal. These study results support holmium laser enucleation as a reference procedure against which other potential new standards for the surgical management of BPH should be compared, according to the researchers.
Although there have been several improvements in the clinical management of BPH, there are still many patients in need of surgical treatment. Based on recent surveys, transurethral resection of the prostate (TURP) is the preferred treatment for BPH. Although TURP has been the standard alternative surgical procedures for BPH, laser techniques have emerged and are beginning to be preferred over TURP. Additionally, newer technologies are being adopted more frequently by experienced surgeons and in academic centers. Holmium laser enucleation of the prostate (HoLEP) has been considered the best option to TURP, especially for large prostatic glands, and its use in BPH has been widely analyzed. Several randomized clinical trials and retrospective studies have validated HoLEP since its introduction into clinical practice back in 1996. Although there is supporting evidence for different surgical interventions for BPH, there is still no agreement concerning the first-line procedure for most patients and clinical situations.
In this study, the researchers evaluated the outcomes of several surgical treatments for benign prostate hyperplasia from patients’ point of view. They reported outcomes using a rigorous method of data collection and presented a detailed analysis of urinary and sexual functional outcomes, as well as general satisfaction/regret for each type of BPH method. Patients enrolled had undergone surgical intervention for the treatment of BPH between 2007 and 2013 at Mayo Clinic (Phoenix, Arizona). The participants were queried by a structured institutional review board–approved survey questionnaire that contained 39 items in 2 formats: 1) multiple-choice questions, where the patient chose the most precise response and 2) free-text responses. The questionnaire included patient urinary, sexual, and quality of life (QoL) outcomes after the procedure and satisfaction and regret after the intervention. The Sexual Health Inventory for Men (SHIM) questionnaire to assess postoperative sexual function, the International Continence Society male Short Form (ICSmaleSF) to address the urinary function such as storage and voiding symptoms, and the International Prostate Symptoms Score (IPSS) questionnaires were also included in the survey. An independent third-party survey center collected the responses and introduced the data into a database.
A total of 906 patients underwent surgical intervention for BPH and at the time of the survey 44 patients were deceased. The group was reduced to 862 patients, were 479 (55.6%) responded to the survey. Among them, there were 21 holmium laser ablation of the prostate (HoLAP), 214 HoLEP, 18 photoselective vaporization of the prostate (PVP), nine transurethral incisions of the prostate (TUIP), 210 TURP and seven open simple prostatectomy (OSP). During the surgery period continence rates were 71.4%, 55.3%, 57.1%, 66.7%, 58.2%, and 80% for HoLAP, HoLEP, PVP, TUIP, TURP, and OSP, respectively.
The researchers found there was a good overall satisfaction for all surgical procedures. Most patients underwent either HoLEP or TURP, reflecting Mayo’s Clinic (Phoenix, Arizona) current practice profile for surgical management of BPH. For HoLAP, TUIP, PVP and OSP surgical procedures, it was impossible to draw significant conclusions due to the small number of patients. Overall, HoLEP had greater satisfaction, less regret, and better QoL outcomes when compared with other surgical strategies. However, the researchers believe that to perform HoLEP there is a need for new genitourinary operative procedures. Moreover, a slow rate of adoption and limited training opportunities are the main obstacles to establish it as a new standard of care.
Overall, the researchers designed a survey that was self-explanatory and rapidly completed by the patient without coaching by providers, transforming a subjective symptom into a more objective score to explore and quantify patient urinary symptoms and difficulties. Besides several acknowledged limitations, such as the retrospective nature of the study and small patient’s number for each procedure, this is the first study to evaluate patient satisfaction and functional outcomes after surgical treatment for BPH using a self-reported, independently administered survey, with detailed urinary outcomes.