Procedure-Related Readmission and Evolving Trends in Transurethral Prostate Surgery for Benign Prostatic Obstruction: A Two-Decade Paradigm Shift

Abstract Background and Objective: Transurethral prostatic surgery (TUPS) has been evolving throughout the past 20 years which impacts procedure related readmissions (PRR). Long-term data about PRR across different techniques are limited. We aim at reporting causes, predictors, and rates of PRR over two decades. Methods: A prospectively maintained prostate database was reviewed for TUPS performed between January 2005 to December 2024 in a tertiary referral center. PRR was reported across 4 consecutive time-periods and across 4 distinct TUPS techniques, namely incision (TUIP), resection (TURP), vaporization and enucleation (AEEP). Regression analysis was used to define predictors of PRR over different time-periods. Key Findings and Limitations: Overall PRR rate was 8.3% (663/8031) at median follow-up of 60 months: 12.9, 8.2, 13.8 and 5.8% following TUIP, TURP, vaporization and AEEP respectively. A 5-year overall PRR-free survival was highest 93.8% (CI 92.6–95.0) in the AEEP group and lowest 84.5% (CI 81.0–88.0) in the vaporization group (P < 0.001). Independent predictors of PRR included older age (OR 1.08 per year), higher BMI (OR 1.04), high ASA score ≥3 (OR 7.87), procedure type (vs. AEEP: TUIP OR 2.79, TURP OR 2.37, vaporization OR 2.71), hematuria at presentation (OR 1.54), and surgeon experience <5 years (OR 1.35). TURP decreased, enucleation increased; regrown adenoma PRR fell, while PPI rose over time. Limitations: retrospective design, potential selection bias, and limited generalizability. Interventions : transurethral incision, resection, vaporization, and AEEP. Conclusions: The lowest PRR was observed following AEEP. Modifiable risk factors for PRR were the surgical technique and the surgeon’s experience.