Comparison of Emergency Room Visits and Rehospitalization for Bleeding Complications following Transurethral Procedures for the Treatment of Benign Prostatic Hyperplasia: A Population-Based Retrospective Cohort Study

Abstract

Background: The postoperative bleeding complications associated with laser surgery of the prostate and transurethral resection of the prostate (TURP) were compared. Methods: We used the Taiwan National Health Insurance Research Database to conduct an observational population-based cohort study. All eligible patients who received transurethral procedures between January 2015 and September 2018 were enrolled. Patients who received laser surgery or TURP were matched at a ratio of 1:1 by using propensity score matching, and the association of these procedures with bleeding events was evaluated. Results: A total of 3302 patients who underwent elective transurethral procedures were included. The multivariable Cox regression analysis revealed that diode laser enucleation of the prostate (DiLEP) resulted in significantly higher emergency room risks within 90 days after surgery due to clot retention than the Monopolar transurethral resection of the prostate (M-TURP) (Hazard Ratio: 1.52; 95% Confidence Interval [CI], 1.06–2.16, p = 0.022). Moreover, GreenLight photovaporization of the prostate (PVP) (0.61; 95% CI, 0.38–1.00 p = 0.050) and thulium laser vaporesection of the prostate (ThuVARP) (0.67; 95% CI, 0.47–0.95, p = 0.024) resulted in significantly fewer rehospitalization due to clot retention than did M-TURP. No significant increase in blood clots were observed in patients using comedications and those with different demographic characteristics and comorbidities. Conclusions: Among the investigated six transurethral procedures for Benign prostatic hyperplasia, PVP and ThuVARP were safer than M-TURP because bleeding events and clot retention were less likely to occur, even in patients receiving anticoagulant or antiplatelet therapy. However, DiLEP and holmium laser enucleation of the prostate (HoLEP) did not result in fewer bleeding events than M-TURP.

Emergency department visits following transurethral resection of prostate in the elderly: Does duration of postoperative catheterization count?

“…In most studies, re-catheterization rates are about 10-12%, which is a composite of both middle and elderly patients. [ 24 , 25 ] The need for re-catheterization is mostly due to bleeding or urinary retention. [ 11 , 19 , 24 , 25 ] This is similar to our findings in this cohort of 41 elderly patients.…”

“…[ 24 , 25 ] The need for re-catheterization is mostly due to bleeding or urinary retention. [ 11 , 19 , 24 , 25 ] This is similar to our findings in this cohort of 41 elderly patients. In a review of 379 consecutive transurethral resections of the prostate, Reynard et al found 10% presented with an inability to void after catheter removal.…”

Progress in Functional Urology Reflected in Recent Papers in the Journal of Clinical Medicine

“…While TURP is considered to be the gold standard of relieving obstruction, it can have complications. A population-based, retrospective cohort study from Taiwan has compared the incidence of emergency room visits and rehospitalization for bleeding complications following TURP or laser-based transurethral procedures for the treatment of BPH [ 17 ]. Using data from the Taiwan National Health Insurance Research Data Base, propensity score matching, and applying a multiple regression analysis, they looked at 1651 patients each receiving laser or TURP treatment between January 2015 and September 2018.…”

Special Issue: “Latest Advances on Urological Surgery”

“…In the context of BPH laser surgery, Chen S-L and colleagues [ 7 ] performed an observational population-based retrospective study evaluating the postoperative bleeding complications among common six laser transurethral techniques and TURP (monopolar or bipolar) using the Taiwan National Health Insurance Research Database. While GreenLight photovaporization (PVP) and thulium laser vaporesection (ThuVARP) of the prostate were associated with a lower incidence of bleeding events and clot retention compared to monopolar TURP, even in patients receiving anticoagulant or antiplatelet therapy, diode laser enucleation (DiLEP) and holmium laser enucleation (HoLEP) did not result in fewer bleeding events than monopolar TURP.…”