National trends in surgical therapy for benign prostatic hyperplasia in Australia

Patel, Rohan M.; Bariol, Simon V.

doi:10.1111/ans.15016

Cited by 20 publications

(15 citation statements)

References 24 publications

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“…Since the turn of the millennium, there has been significant change in the management of BPH in Australia. The data presented here provides a contemporary analysis of BPH surgery and contribution to national hospitalisations [22], with population-adjustment and analysis of trends in BPH medical therapy and financial burden. These data demonstrated that the overall rate of all BPH procedures rose by 39% across the study period.…”

Section: Discussionmentioning

confidence: 99%

Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population‐based data

et al. 2020

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Objective To examine national trends in the medical and surgical treatment of benign prostatic hyperplasia (BPH) using Australian Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) population data from 2000 to 2018. Patients and methods Annual data was extracted from the MBS, PBS and Australian Institute of Health and Welfare databases for the years 2000–2018. Population‐adjusted rates of BPH procedures and medical therapies were calculated and compared in relation to age. Cost analysis was performed to estimate financial burden due to BPH. Results Overall national hospital admissions due to BPH declined between 2000 and 2018, despite an increased proportion of admissions due to private procedures (42% vs 77%). Longitudinal trends in the medical management of BPH showed an increased prescription rate of dutasteride/tamsulosin combined therapy (111 vs 7649 per 100 000 men) and dutasteride monotherapy (149 vs 336 per 100 000 men) since their introduction to the PBS in 2011. Trends in BPH surgery showed an overall progressive increase in rate of total procedures between 2000 and 2018 (92 vs 133 per 100 000 men). Transurethral resection of the prostate (TURP) remained the most commonly performed surgical procedure, despite reduced utilisation since 2009 (118 vs 89 per 100 000 men), offset by a higher uptake of photoselective vaporisation of prostate, holmium:YAG laser enucleation of prostate, and later likely due to minimally invasive surgical therapies including prostatic urethral lift and ablative technologies (including Rezūm™). Financial burden due to BPH surgery has remained steady since 2009, whilst the burden due to medical therapy has risen sharply. Conclusion Despite reduced national BPH‐related hospitalisations, overall treatment for BPH has increased due to medical therapy and surgical alternatives to TURP. Further exploration into motivators for particular therapies and effect of medical therapy on BPH progression in clinical practice outside of clinical trials is warranted.

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Section: Discussionmentioning

confidence: 99%

Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population‐based data

et al. 2020

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“…This dropped to 73% from 2008 to 2014. In 2014 to 2017, 15.5% of procedures were PVP and 7.7% and 5.9% were UroLift® and HoLEP, respectively [91]. A similar decline in the rate of TURP was seen in America with a drop of 47.6% from 2000 to 2008, in favor of PVP, TUNA, and TUMT [92].…”

Section: Newer Therapies For Bphmentioning

confidence: 96%

Minimizing Sexual Dysfunction in BPH Surgery

Leong

Patel

Ramasamy

2019

Curr Sex Health Rep

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Purpose of Review To review the prevalence and risks of sexual dysfunction associated with current treatment options for benign prostatic hyperplasia and to characterize techniques and methods to manage postoperative sexual dysfunction-related side effects. Recent Findings Current surgical therapies available for the treatment of benign prostatic hyperplasia are associated with a substantial risk of both ejaculatory and erectile function. However, many of the novel minimally invasive treatment alternatives have demonstrated the ability to preserve postoperative sexual function to a better degree, all while providing significant relief of lower urinary tract symptoms in an equally safe and efficacious manner. Summary Benign prostatic hyperplasia remains a highly prevalent disease among the aging population. While surgical treatments are often necessary to relieve bothersome urinary symptoms, these procedures are associated with an increased risk of sexual dysfunction. As such, there has been an increased interest in the development of minimally invasive therapies, such as the UroLift®, Rezum®, and Aquablation®, with the hopes of achieving similar symptomatic relief while maintaining sexual function. Aside from reporting lower rates of sexual dysfunction, these procedures have also demonstrated comparable safety, durability, and efficacy to current gold standard therapies. Some procedures can even be performed in an outpatient setting, avoiding the need for general anesthesia altogether. Overall, an individualized, shared decision-making approach is necessary to determine the ideal treatment option for each patient.

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“…In low‐ and middle‐income countries (most of the world's population), even a bipolar electrocautery may present an investment that is not achievable. The need for a high‐power laser generator, laser fibres, and morcellators is an obstacle to the popularity of aEEP (Jeon et al., 2019; Naspro et al., 2017; Patel & Bariol, 2019).…”

Section: Multiple Energy Sources and Techniquesmentioning

confidence: 99%

Anatomical endoscopic enucleation of the prostate: The next gold standard? No! (or not yet!)

2020

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Most cases of lower urinary tract symptoms due to benign prostatic hyperplasia are initially managed through medical therapy. In cases that surgery is indicated, the anatomical endoscopic enucleation of the prostate (aEEP), first described in 1983, allegedly presents the same safety profile as the best endoscopic non-enucleating procedures and the same long-term functional outcomes as simple prostatectomy. Thus, why aEEP has not yet been consolidated as the gold-standard BPH surgical treatment? The main reasons are as follows: (a) Multiple energy sources and techniques; (b) High costs; (c) Steep learning curve; (d) Rare in-residency training; (e) Reimbursement issues; (f) Outcomes and (g) Complications. We do believe aEEP is an important advance and a "practice-changing" procedure that will play an important role in the BPH surgical options arsenal, especially for larger prostates. However, there is a need to start an in-residency training program, with a mentor guidance, and, over time, the cost will likely be reduced due to greater competition between companies and greater support from health insurers. Considering these points, in the future, EEP may be considered the gold-standard treatment for BPH… but not yet. K E Y W O R D S endoscopic surgical procedure, prostate, prostatic hyperplasia, standard of care, urologic surgical procedures How to cite this article: Wroclawski ML, Teles SB, Carneiro A. Anatomical endoscopic enucleation of the prostate: The next gold standard? No! (or not yet!). Andrologia.

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National trends in surgical therapy for benign prostatic hyperplasia in Australia

Cited by 20 publications

References 24 publications

Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population‐based data

Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population‐based data

Minimizing Sexual Dysfunction in BPH Surgery

Anatomical endoscopic enucleation of the prostate: The next gold standard? No! (or not yet!)

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