Use of Medical Therapy and Success of Laser Surgery and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

Abstract

To assess the impact of surgery for benign prostatic hyperplasia (BPH) on use of medication (5-alpha reductase inhibitors, alpha blockers, antispasmodics), we assessed preoperative and postoperative medication utilization among surgically treated men. Using the Truven Health Analytics MarketScan Commercial Claims Database, we defined a cohort of men aged<65years who had surgical therapy for BPH with either transurethral resection of the prostate (TURP) or laser procedures from 2007 through 2009. Primary outcomes included freedom from medical or surgical intervention by 4months after surgery (chi-square and multivariable logistic regression) and subsequent use of medical or surgical intervention in initial responders (Kaplan-Meier and multivariable Cox regression). We identified 6430 patients treated with either TURP (3096) or laser procedure (3334) for BPH. Presurgical antispasmodic use was associated with the highest risk of medication use at 4months after surgery (odds ratio, 5.19; 95% confidence interval (CI), 3.16-8.53 vs no medication use before surgery). At 3years after surgery, 6% (95% CI, 4%-8%) of laser-treated and 4% (95% CI, 2%-5%) of TURP-treated patients had repeat surgical intervention, and both laser- and TURP-treated patients had an estimated new use of medication rate of 22% (95% CI, 18%-25% laser and 20%-25% TURP). The strongest predictor of intervention after surgery was preoperative antispasmodic use (hazard ratio, 2.49; 95% CI, 1.41-4.43). Our results show a need for effective patient counseling about continued or new use of medical therapy after laser and TURP procedures. However, most patients experience durable improvement after surgical intervention for BPH.