There are no established statistical data available for the comparison of different surgical methods adopted for the resection of benign prostatic hyperplasia (BPH) in Korea. This study investigates the present status related to BPH surgery in Korea for the past 8 years.

National-level data from the National Health Insurance Service and National Statistical Office were analyzed in this study. From 2010 to 2017, The trends of surgeries for BPH were reviewed according to the procedure code including transurethral resection of the prostate (TURP), holmium laser enucleation prostate surgery (HoLEP), or high-power potassium titanyl phosphate (KTP), and this trend also analyzed by age, geographic distribution, and hospital type.

Over the past 8 years, there was no significant difference in the total number of operations between 2010 (10,393) and 2017 (11,072). TURP remained the most commonly performed operation for transurethral prostate surgery. Total number of conventional TURP remained stable  (from 6,801 in 2010 to 6,645 in 2017). KTP was the second common operation in 2010 and 2011, but the number of KTP showed a gradual decrease from 3,314 to 2,751, and eventually dropped to 622 in 2017. On the other hand, the number of HoLEP dramatically increased. In 2010, the number of HoLEP was only 278, but the number steadily increased, and finally exceeded the number of KTP in 2012, with a continuing steady increase in the difference (Fig. 1). The number of surgeries by age group was most common in the 70s and the total number of surgeries is decreasing in all age groups; for HoLEP, the trend is steadily increasing over the age of 60 years(Fig. 2). Most of the BPH surgeries were performed in metropolitan areas, such as Seoul, Gyeonggi, and Busan, and in larger hospitals compared to smaller hospital settings.

Currently available surgeries for BPH in Korea are TURP, KTP, HoLEP, open prostatectomy, and Prostate ligation (UroLift System, NeoTract, Inc., Pleasanton, CA, USA). All of the procedures mentioned are available in Korea. HoLEP is rapidly replacing other open BPH operations since its introduction, and open prostatectomy is no longer performed. Currently, the most commonly performed surgeries in Korea are TURP, KTP, and HoLEP. The health insurance claim data provided by HIRA is a representative data of the medical contents of the all citizens and has representative and inclusiveness. In our present study, the traditional TURP was found to be the most common among the prostate surgeries, and the number of surgeries remained stable for 8 years. The number of HoLEP has surged rapidly, surpassing the number of KTPs since 2012. These results were comparable to other studies conducted in US, Canada, and Japan [1-3]. Previous studies have reported TURP to be the most common procedure without a significant difference in the number of operations. Further, laser treatments including HoLEP and KTP showed an increase forming the second most common treatment for BPH. However, the rates of total number of operations with TURP and laser therapies vary between countries due to the differences in the study period, the time of introduction of BPH procedures, acquisition costs, different reimbursement incentives, and insurance policies. In this study, the number of operations per 100,000 BPH patients tended to decrease in all age groups. This decrease might be attributed to the large number of new drugs that have been recently developed for the lower urinary tract symptoms due to BPH. It has been reported that the most common age group to receive the BPH surgeries is the 70s. This might indicate that the overall health status and morbidity of the BPH surgeries have improved in the older age groups. In addition, BPH surgeries are mainly conducted in the big cities or metropolitan areas where large hospitals are located rather than based on the absolute number or regional distribution of urology patients. This in turn implies that most of the HoLEP surgeries are mainly performed in large hospitals.

Through the data of the National Health Insurance Service, we could apprehend the present status of BPH-related surgery in Korea. Then, we could know about the trend according to several factors and we think these results will be valuable as academic references as well.

Masumori N, Kamoto T, Seki N, Homma Y; Committee for Clinical Guideline for Benign Prostatic Hyperplasia. Surgical procedures for benign prostatic hyperplasia: a nationwide survey in Japan. Int J Urol 2011;18:166-70.
Hueber PA, Zorn KC. Canadian trend in surgical management of benign prostatic hyperplasia and laser therapy from 2007-2008 to 2011-2012. Can Urol Assoc J 2013;7:E582-6.
Schroeck FR, Hollingsworth JM, Kaufman SR, Hollenbeck BK, Wei JT. Population based trends in the surgical treatment of benign prostatic hyperplasia. J Urol 2012;188:1837-41.