[Treatment mapping of lower urinary tract symptoms due to benign prostatic hyperplasia-an analysis of the Governing Body of German Prostate Centers]

BACKGROUND

Due to the high incidence and demographic development, there is an urgent need for healthcare research data on lower urinary tract symptoms due to benign prostatic hyperplasia (LTUS/BPH). Since 2005 the Governing Body of German Prostate Centers (DVPZ) has been collecting data from 22 prostate centers in order to determine the quality and type of cross-sectoral care in particular for LUTS/BPH patients.

OBJECTIVES

Presentation of the DVPZ database in general, as well as an investigation of treatment patterns for medical and instrumental therapies.

MATERIALS AND METHODS

The analysis is based on UroCloud data sets from 30 November 2017. In the UroCloud data on diagnostics, therapy and course of disease are recorded in a web-based manner.

RESULTS

A total of 29,555 therapies were documented for 18,299 patients (1.6/patient), divided into 48.5% instrumental, 29.2% medical treatment, and 18.0% "wait and see" (in 4.3% no assignment was possible). Patients treated with an instrumental therapy were oldest (median: 72 years, interquartile range: 66-77), had the largest prostate volumes (50 ml, 35-75 ml), and were mostly bothered by symptoms (International Prostate Symptom Score = 19/4). The majority of patients under medical treatment received alphablockers (56%); phytotherapeutics were used least frequently (3%). Instrumental therapies are dominated by transurethral resection (TUR) of the prostate (60.0%), open prostatectomy (9.4%) and laser therapy (5.0%), with laser therapy having the shortest hospital stay (5 days) and the lowest transfusion and re-intervention rates (1.0% and 4.6%, respectively).

CONCLUSIONS

The DVPZ certificate covers the complete spectrum of cross-sectoral care for LUTS/BPH patients and documents the use of the various therapies as well as their application and effectiveness in the daily routine setting.

Nosocomial infections after transurethral prostatectomy

In spite of new techniques transurethral prostatic resection (TURP) remains the gold standard in operative therapy of benign prostatic hyperplasia. There are some suggested risk factors for TURP which could affect the rate of postoperative complications. In this prospective study we investigated whether the suggested risk factors have any relevance for the occurrence of nosocomial urinary tract infections (UTIs) after TURP and what kind of influence these infections may have on the clinical course. In general we found no statistically significant influence on the analyzed risk factors for the incidence of nosocomial UTIs. On the other hand in the group of patients with nosocomial UTIs both the rate of other nosocomial infections (i.e. septicemia) and the rate of inflammatory complications were significantly higher compared to the group without postoperative UTIs (p < 0.001). We conclude that all patients undergoing TURP should receive perioperative antimicrobial prophylaxis.