BPH Patients Increasingly Likely to Postpone Surgery, Study Finds

BPH Patients Increasingly Likely to Postpone Surgery, Study Finds

A McGill University study reports on the changing characteristics of patients with benign prostatic hyperplasia (BPH) over 16 years — finding that the patient population is older and sicker.

The study, “Changing patients’ profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-center perspective,” published in the Canadian Urological Association Journal, investigated the profiles of 1,835 patients who had laser prostate surgery between 1998 and 2014. The research team divided the patients into three groups: individuals who had surgery before 2004, between 2004–09, and between 2009–14.

The team explored a large number of parameters, including international prostate symptoms score (IPSS), quality of life, peak urinary flow rate, post-void residual urine, and prostate volume. Information about age and the presence of other conditions, such as diabetes or coagulopathy, prostatic medication use, and previous surgeries, were also examined.

The analysis showed that patients in the third group — surgery between 2009 and 2014 — were older, more coagulopathic, and had larger prostates than earlier groups. They also had more overall comorbidities, higher IPSS and quality of life scores (indicating worse BPH symptoms), as well as a lower peak urinary flow rate.

The use of prostatic drugs increased over time, with 72.6 percent of patients using the drugs between 1998 and 2004, 85.5 percent between 2000–09, and 87.4 percent in the most recent group. Patients in the two most recent groups also had indwelling urethral catheters because of urinary retention more often than the earliest group.

In spite of the different patient characteristics, the safety, re-operation rates and frequency of complications were similar in the three groups, possibly due to advances in laser technology and surgical techniques. The only difference noted was a gradual reduction in the occurrence of urethral stricture with time. This might be explained by the lower rates of earlier prostate surgery in the most recent group.

An interesting observation was that despite the steep learning curve of surgeons during this time, postoperative urinary incontinence was less frequent in the earliest time group.

The study highlights what is considered to be a growing trend: BPH patients wait longer before opting for surgery, leading to surgery on larger prostates and a more frequent adaptation of transurethral enucleation techniques.

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