PD56-03: National Surgical Trends in Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia

Charles Welliver, Lydia Feinstein , Julia B. Ward , Kevin C. Abbott, Tamara Bavendam, Ziya Kirkali, Erline Martinez-Miller, Brian R. Matlaga, Kevin McVary

Introduction: Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) is a chronic disease causing significant morbidity and quality of life impairment among men. Pharmacotherapy is the common treatment, and surgical management is often reserved for refractory disease. Our current understanding of trends in surgical treatment of BPH is limited to studies that predominantly focus on older men. We assessed trends in the surgical management of LUTS/BPH across 10 years in a large, national sample of older and working aged men.

Methods: As part of the Urologic Diseases in America project, we analyzed two insurance claims databases over the 2004-2013 study period: the Centers for Medicare & Medicaid Services Medicare 5% Sample for male Medicare beneficiaries aged =65 years with LUTS/BPH (N˜147,800 annually) and the Optum© de-identified Clinformatics® Data Mart Database for privately insured males aged 40-64 years with LUTS/BPH (N˜100,300 annually). We examined age and temporal trends in the percentage of patients who underwent surgery to treat LUTS/BPH. Surgical procedures included: open prostatectomy (OP), transurethral needle ablation (TUNA), transurethral resection of the prostate (TURP), laser prostatectomy (LP), Transurethral incision of the prostate (TUIP), and transurethral microwave therapy (TUMT).

Results: Surgical procedure prevalence and time trends varied by age (Figure 1). Throughout the study period, surgical treatment of LUTS/BPH was higher among patients =65 years of age compared to patients 40-60 years of age (3-5% vs. 2%). Surgical procedures for LUTS/BPH decreased by 40% over the study period in the older population but remained stable in the younger population.  Among older patients, TURP was most commonly utilized (45%), followed by LP (30%), TUMT (17%), TUNA (5%), OP (2%) and TUIP (1%). Among younger patients, TURP (38%) was more closely followed by LP (31%) and then TUMT (18%), TUNA (8%), TUIP (3%) and OP (2%).

Conclusions: Over a 10-year span, older LUTS/BPH patients had a higher prevalence of surgical procedures than younger LUTS/BPH patients, and TURP and LP were the most commonly performed procedures. There was a dramatic reduction in surgical therapy for LUTS/BPH among older but not younger patients. Source of

Funding: Funded by the NIH via a contract to Social & Scientific Systems.