Increasing TURP Re-treatment Rates in Veterans: 1996–2024 VA Data Analysis
Overview
This study analyzed 37,991 Veterans undergoing TURP between 1996 and 2024, revealing higher reoperation rates in patients treated after 2001. Despite advances in medical management and surgical technology, TURPs performed in the 21st century were associated with increased likelihood of re-treatment within five years.
Background
Benign prostatic hyperplasia (BPH) is a common condition in aging men causing lower urinary tract symptoms due to prostate enlargement. Transurethral resection of the prostate (TURP) has been the gold standard surgical treatment since 1926. However, evolving medical therapies and new surgical technologies have changed practice patterns, potentially influencing TURP durability and re-treatment rates. This study investigates whether the era of TURP surgery correlates with reoperation and complication rates using Veterans Affairs data.
Data Highlights
Characteristic
Pre-2001 TURP
2001–2024 TURP
p-value
Charlson Comorbidity Index = 0
44.8%
31.8%
<0.001
BMI > 30
17.9%
24.1%
<0.001
On BPH Medications Pre-op
25%
75%
<0.001
Pre-op Urinary Incontinence
5.6%
10.7%
<0.001
Pre-op Urinary Retention
36.3%
41.1%
<0.001
Key Findings
Patients undergoing TURP before 2001 were generally healthier with lower BMI and fewer comorbidities.
Use of medical therapy for BPH prior to TURP increased significantly after 2001 (25% vs. 75%).
TURPs performed after 2001 were associated with higher rates of reoperation within five years.
Preoperative urinary incontinence and retention were more common in the post-2001 TURP group.
Changes in surgical technique and increased medical management may contribute to less durable TURP outcomes in the 21st century.
Clinical Implications
Clinicians should be aware that TURPs performed in the modern era may carry a higher risk of re-treatment, possibly due to less aggressive tissue resection or patient selection influenced by prior medical therapy. Counseling patients on the likelihood of needing additional procedures post-TURP is important, especially in those with preoperative urinary symptoms or comorbidities. Consideration of surgical technique and patient characteristics remains critical for optimizing long-term outcomes.
Conclusion
This large VA cohort study demonstrates increasing TURP re-treatment rates in the 21st century, highlighting the need to reassess surgical strategies and patient counseling in the evolving landscape of BPH management.
References
Veterans Health Administration Data Analysis 1996–2024 -- Increasing Rates of TURP Re-treatment
