Long-term patterns of surgical reintervention after various benign prostatic hyperplasia procedures in a large national database.

INTRODUCTION

The surgical management of benign prostatic hyperplasia (BPH) has expanded significantly over the past two decades with the introduction of minimally invasive techniques. As treatment options grow, understanding real-world patterns and timing of surgical retreatment is essential to inform shared surgical decision-making. This study evaluates long-term surgical reintervention rates following common surgical procedures for BPH using a live national database.

METHODS

We conducted a retrospective, observational study using the TriNetX Diamond Network, which aggregates electronic health records from over 120 million patients across 73 U.S. healthcare organizations. Adult males aged 18 years or older diagnosed with BPH who underwent a first-time surgical procedure between 2005 and 2025 were included. Cumulative surgical reoperation rates were assessed at predefined intervals up to 10 years following the index procedure. Reoperation was used as a marker for surgical retreatment, recognizing it does not capture all forms of treatment failure. Statistical comparisons were performed using Chi-squared tests, with significance set at p<0.05.

RESULTS

A total of 103 019 patients met inclusion criteria, of whom 7687 (7.5%) underwent a re-operation within 10 years. Open simple prostatectomy demonstrated the lowest long-term reoperation rate, followed by holmium laser enucleation of the prostate. Procedures such as robotic waterjet ablation and water vapor thermal therapy had shorter followup windows due to recent adoption. Reoperation rates differed significantly across procedures at each interval (p<0.0001). Transurethral resection of the prostate was the most common secondary procedure, except in patients initially treated with laser enucleation or prostatic artery embolization, where same-modality retreatment predominated.

CONCLUSIONS

This large, real-world study offers long-term data on reintervention patterns between various BPH procedures, and may inform patient counseling regarding the likelihood and timing of additional interventions.