Temporal and Geographic Trends in Surgical Management of Benign Prostatic Hyperplasia in the United States Veteran Population.

OBJECTIVES: To examine temporal trends in the surgical management of benign prostatic hyperplasia among Veterans and the utilization of new minimally invasive surgical therapies. METHODS: We queried the Veterans Affairs Corporate Data Warehouse database from 1/1/2000 to 10/20/2024 to identify male Veterans with benign prostatic hyperplasia. We assessed the rates of different procedures and analyzed the trends over time and across geographic regions. RESULTS: A total of 74,434 patients underwent surgery. Transurethral resection of the prostate was the most common procedure. The average Charlson Comorbidity Index at time of surgery progressively increased from 3.7 in 2000 to 7.3 in 2024. Patient age (r2 = 0.46, p<.01) and year of BPH procedure (r2 = 0.91, p<.01) correlated with rising Charlson Comorbidity Index. Photoselective vaporization of the prostate was the second most used procedure before a gradual increase in prostatic urethral lift from 2015 to a peak of 13.9% in 2021. CONCLUSIONS: Men undergoing benign prostatic hyperplasia procedures in the Veterans Affairs system present with progressively greater medical complexity, more strongly associated with year of surgery than patient age alone. Transurethral resection of the prostate remains predominant despite newer alternatives. Prostatic urethral lift had surpassed photoselective vaporization of the prostate as the second most popular option in recent years. However, transurethral resection of the prostate utilization has risen since 2021 with a corresponding decrease in prostate urethral lift.