Comparing TURP and laser prostate surgery for benign prostatic hyperplasia in older patients and those with multiple medical conditions

This study compared the safety and effectiveness of transurethral resection of the prostate (TURP) and laser prostate surgery in older patients and those with multiple medical conditions. The data showed that compared to laser surgery, TURP had a lower risk of needing further surgery but higher complications rates in these patients.

Benign prostatic hyperplasia (BPH) is a condition that is more common in older men. It involves a non-cancerous growth of the prostate gland. It causes lower urinary tract symptoms such as needing to urinate during the night, a problem in starting urination, and a feeling of incomplete bladder emptying. The gold-standard surgical approach for BPH is transurethral resection of the prostate (TURP). This involves the surgical removal of the prostate through the urethra (tube that passes urine out of the bladder). However, TURP is associated with complications that may be especially important to patients with two or more medical conditions or those that are older.

An emerging, alternative approach for such patients is laser prostate surgery (LPS). LPS includes multiple techniques that involve a laser to remove excess prostate tissue blocking urine flow. However, limited data is available regarding the safety and effectiveness of TURP compared to LPS in older patients or those with multiple medical conditions.  

This study involved 12,815 patients with multiple medical conditions and 29,806 men aged 75 or older. All men had BPH. Patients were separated into 2 groups based on the treatment they received. Group 1 received LPS and group 2 received TURP.  

In patients with multiple medical conditions, TURP was associated with an 8% reduction in hospital readmission and ER visits after 90 days of surgery compared to LPS. TURP was also associated with a 17% reduction in the risk of having a urinary infection and a 19% reduction in the risk of needing another surgery in the next 6 months compared to LPS. However, TURP was associated with a 53% higher risk of developing a narrowing of the bladder outlet within the next 6 months.

In patients aged 75 and older, TURP was associated with a 7% higher risk of hospital readmission and ER visits compared to LPS. TURP was also associated with a 28% higher risk of blood in the urine compared to LPS. However, TURP was associated with a 20% lower risk of needing another surgery for BPH in the following 6 months compared to LPS.  

The study showed that TURP had better effectiveness while increasing the risk of complications in older patients and those with multiple medical conditions.  

The study considered 75 years of age or more to indicate frailty. Patient data for LPS was based on multiple laser techniques. Further studies are needed to directly compare TURP with each laser technique.