Abstract
ObjectivePharmacotherapy is often used to relieve lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), yet surgery may be indicated for persistent bothersome symptoms. BPH is common among older men, yet the burden of BPH among middle-aged men may be under-recognized. This study examined the 5-year risk of BPH surgery among middle-aged men following the first BPH diagnosis.MethodsUsing the IBM MarketScan Commercial Claims and Encounters Database, males aged 35 to 64 years with a first-time primary diagnosis of BPH who were prescribed oral medication for LUTS were identified. The primary outcome was the risk of BPH surgery within five years of the first BPH diagnosis, which was analyzed using Kaplan-Meier methods. The influence of patient demographics, comorbidities, and medication use on the risk of BPH surgery was explored using a Cox proportional hazards model. ResultsFour thousand five hundred ten eligible men, 460 underwent BPH surgery within five years of BPH diagnosis. The most common surgical procedures were transurethral resection of the prostate and laser enucleation. The risk of BPH surgery over five years following BPH diagnosis was 10.2% (95% CI: 9.4% to 11.1%). In a multivariable Cox proportional hazards regression analysis, patient age was the primary factor associated with higher surgery risk. Compared to men aged 35 to 44 years, the hazard ratio for BPH surgery was 3.9 (95% CI: 1.9 to 8.4; p<0.001) among men aged 45 to 54 years, and 5.0 (95% CI: 2.4 to 10.6; p<0.001) among men aged 55 to 64 years.ConclusionsIn middle-aged men prescribed oral medication for LUTS secondary to BPH, the risk of BPH surgery was 10.2% over five years. This risk may be underappreciated and highlights the clinical need for surgical procedures with favorable risk-to-benefit profiles.
Highlights
The risk of Benign prostatic hyperplasia (BPH) surgery over five years following BPH diagnosis was 10.2%
Benign prostatic hyperplasia (BPH) is a histological diagnosis characterized by prostatic tissue overgrowth around the urethra that affects most men during their lifetime [1]
In a systematic review characterizing the global burden of lower urinary tract symptoms (LUTS) secondary to BPH, moderate or severe LUTS were reported in 14.8% of men aged 40 to 49 years and 36.8% of men aged 70 to 79 years [2]
Summary
Benign prostatic hyperplasia (BPH) is a histological diagnosis characterized by prostatic tissue overgrowth around the urethra that affects most men during their lifetime [1]. Medical management with an alpha-blocker or a 5-alpha reductase inhibitor is often recommended as a first-line management approach for bothersome LUTS secondary to BPH. For patients with bothersome LUTS who fail medical therapy, BPH surgery may be indicated. Surgical treatment options for men with BPH range from less invasive procedures with higher reintervention rates such as transurethral microwave therapy (TUMT) and transurethral needle ablation (TUNA) that can be performed in an office setting to procedures that are more invasive but with lower reintervention rates such as transurethral resection of the prostate (TURP). The risk of surgery is well characterized among older men with BPH. The risk among middle-aged men with bothersome LUTS remains unclear. The primary purpose of this study was to characterize the 5-year risk of BPH surgery among middle-aged men following the first BPH diagnosis. This study explored risk factors for BPH surgery in this patient population
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