Presentation Authors: Jeffrey Campbell*, London, Canada, Jennifer Reid, Michael Ordon, Toronto, Canada, Blayne Welk, London, Canada
Introduction: Transurethral prostatectomy (TURP) is an operation that requires significant practice to attain true proficiency. Medical management of benign prostatic hyperplasia (BPH) has decreased trainees' exposure to TURP. Our objective is to determine if the reoperation rate after an initial TURP is different among urologists trained in the medical management era compared to their more senior colleagues.
Methods: We conducted a population-based retrospective cohort study of men older than 40 years of age who had their first TURP between 2003-2016 in Ontario, Canada. Our primary exposure was the year of medical school graduation: those graduating prior to 1995 were considered the high-volume TURP generation, and those graduating after 1995 were considered the low-volume TURP generation. Our primary outcome was a repeat TURP being performed more than 14 days after the initial procedure. Several relevant covariates were measured. Our primary analysis was an adjusted marginal cox regression model which accounted for covariates, patient clustering within surgeons and surgeons' prior TURP experience.
Results: We identified a total of 78,176 men with a median age of 72 (IQR 65-79). Men who were treated by the high-volume TURP generation of urologists (n=63,223) were less likely to use a laser-based modality (10.6% vs 17.8%, p < 0.01). A total of 314 different urologists performed TURPs over the study period, and median number of prior TURPs performed was 402 (IQR 232-720) for the high-volume generation versus 172 (IQR 73-331) for the low-volume generation. After a median follow up of 5 years (IQR 2-8), the repeat TURP rate/100 person-years (95% CI) was 2.05 (2.00-2.10) for patients treated by the high-volume generation vs 2.63 (2.50-2.76) treated by the low-volume generation. In our adjusted survival model, the hazard ratio for reoperation was 1.18 (95% CI 1.11-1.26, p < 0.01) among the low-volume TURP generation compared to the high-volume TURP generation.
Conclusions: There is a small but measurable increase in repeat TURP when the procedure is performed by urologists who started independent practice after 2000. This discrepancy may be due to a decreased exposure to TURP during residency.
Source of Funding: St. Josephs Health Care London, Foundation