Mortality, risks, and trends in surgery for benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a prevalent age-related condition among men and is a common cause of quality of life-impairing lower urinary tract symptoms (LUTS). Although transurethral procedures to relieve LUTS are generally considered low risk, a subset of patients experience significant short- and long-term morbidity, and, in some cases, mortality. In this thesis, trends in surgical utilisation in Finland were assessed. Short- and long-term risks between photoselective vaporisation of the prostate (PVP) and transurethral resection of the prostate (TURP) were compared, and postoperative mortality and its risk factors after surgery for LUTS were evaluated. The incidence of surgical interventions for LUTS remained stable (263 per 100,000) despite demographic changes. Hospital stays were shortened, while treated patients grew older. The observed trends between 2004 and 2018 reflected a shift toward outpatient care and delayed intervention, likely influenced by pharmacotherapy and the adoption of PVP. PVP showed a lower risk of reoperation due to bleeding (0.9%), which was even more pronounced in patients with atrial fibrillation. However, in the long-term 12-year follow-up, the reoperation rate after PVP was higher (23.5% vs 17.8% with TURP). These results underscored the short-term safety of PVP, particularly for patients with heightened bleeding risk. They also highlighted its limitations with respect to long-term durability compared to TURP. The real-world overall 90-day postoperative mortality rate was 1.10%, with excess mortality remaining below 0.5% across all age groups. PVP was associated with a lower mortality rate (0.59%) than TURP (1.16%). Age, Charlson Comorbidity Index, atrial fibrillation, and earlier study era were identified as independent risk factors for mortality. These studies emphasise the importance of tailoring treatment strategies to individual patient profiles. They also highlight the need to enhance preoperative risk assessment and to pursue further research into durable surgical options to optimise the management of LUTS in an aging demographic.