Adoption and Outcomes of HoLEP in the United States.
Academic Article
Overview
abstract
OBJECTIVES: To investigate the utilization of holmium laser enucleation of the prostate (HoLEP) using a large real-world cohort. We compare the safety, readmission, and retreatment rates of HoLEP to other widely used endoscopic surgical interventions for benign prostatic hyperplasia (BPH) including transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), and prostatic urethral lift (PUL). METHODS: Men who underwent endoscopic treatments for BPH from 2000-2019 were identified in the Premier Healthcare Database (n=218,793). We compared the relative proportion of each procedure performed and annual physician volume data to identify trends in adoption and utilization. Readmission and retreatment rates were determined at both 30- and 90- days post-operation. Multivariable logistic regression was used to assess the association between procedure type and outcomes. RESULTS: HoLEP accounted for 3.2% (n=6,967) of all BPH procedures performed between 2000 and 2019 and increased from 1.1% of procedures in 2008 to 4% in 2019. Patients undergoing HoLEP had a lower odds of 90-day readmission compared to TURP (OR 0.87, p=0.025). HoLEP had similar odds of retreatment compared to TURP at both 1- year (OR 0.96, p=0.7) and 2-years (OR 0.98, p=0.9), while patients undergoing PVP and PUL were more likely to be retreated within 2-years (OR 1.20, p<0.001; OR 1.87, p<0.001). CONCLUSIONS: HoLEP is a safe therapy for BPH with lower readmission and comparable retreatment rates to the gold standard TURP. Despite this, the utilization of HoLEP has lagged behind other endoscopic procedures and remains low.
