A real-world evidence study of interhospital variability in the surgical treatment of patients with benign prostatic hyperplasia: the REVALURO study

Purpose Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) is a growing condition in males associated with a high clinical, economic and humanistic burden. Several surgical techniques are available for the treatment of LUTS/BPH; thus, the aim of this study was to describe and explore the variability in the use of surgical procedures among Spanish hospitals. Methods The REVALURO was a retrospective, observational study conducted by collecting data from the clinical records of patients with LUTS/BPH aged >= 35 years, from 5 national reference hospitals, who were surgically treated between 2018 and 2022. Results Among the 3038 patients who underwent 3084 surgeries, 66% were invasive (2018: 57.5%, 2022: 71.5%), 22% were minimally invasive (MISTs) (2018: 20.7%, 2022: 20.2%) and 12% were highly invasive (2018: 21.8%, 2022: 8.4%). A total of 22.4% of patients' complications, with a maximum incidence of 28.6% (open prostatectomy) and a minimum 0.8% (water vapor thermal therapy (WVTT)] (p < 0.001). The reintervention rate was 1.5% over the study period. The median length of hospital stay after surgery increased from 0 days (interquartile range [IQR]: 0) with WVTT to 5 days (IQR: 4-8) with open prostatectomy (p < 0.001). Conclusion Trends in surgical treatment showed that the use of invasive techniques increased, while the use of highly invasive techniques decreased, and the use of MISTs remained constant. However, given the heterogeneity among hospitals, national clinical guidelines and recommendations are needed to guide the decision on which technique should be used and to homogenize the criteria.