Utilization of Laser Enucleation of the Prostate in United States Academic Centers

Objective: As with many new surgical techniques, Holmium and Thulium laser enucleation of the prostate has a steep learning curve with slowly increasing availability to patients. This study sought to evaluate the patient characteristics associated with utilization of laser enucleation of the prostate (LEP) across nationwide academic centers. Methods: The Clinical Practice Solutions Center database was queried to identify men 40 years or older who had procedural intervention for benign prostatic hyperplasia based on International Classification of Diseases-10 and Current Procedure Terminology codes specific to LEP, transurethral resection of the prostate (TURP), laser vaporization, laser coagulation, transurethral incision, microwave thermotherapy, needle ablation, radiofrequency thermotherapy, water vapor thermotherapy, and prostatic urethral lift surgeries. Patient characteristics were analyzed with a mixed effects logistic regression model, including age by decade, race, insurance, and social deprivation index. Results: The analysis included 12,670 patients from 64 centers who underwent surgery. TURP was performed most commonly (40.0%) compared with LEP (24.4%). Every decade in older than 50 years had significantly higher odds of undergoing LEP. Hispanic subjects had significantly higher odds of undergoing LEP. Patients with the least social deprivation had 67% greater odds of receiving LEP than those with the most social deprivation ( P = .01). Conclusions: Multiple factors affect physician and patient choices of treatment. This study demonstrated that older age and Hispanic ethnicity were associated with higher utilization of LEP, while higher social deprivation correlated with lower use of the most durable procedure.