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. 2015 Dec;86(6):1115-22.
doi: 10.1016/j.urology.2015.07.019. Epub 2015 Sep 12.

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

Seth A Strope  1 , Joel Vetter  2 , Sean Elliott  3 , Gerald L Andriole  2 , Margaret A Olsen  4
Affiliations

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

Seth A Strope et al. Urology. 2015 Dec.

Abstract

Objective: 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.

Patients and methods: Using the Truven Health Analytics MarketScan Commercial Claims Database, we defined a cohort of men aged <65 years 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 4 months 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).

Results: 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 4 months after surgery (odds ratio, 5.19; 95% confidence interval (CI), 3.16-8.53 vs no medication use before surgery). At 3 years 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).

Conclusion: 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.

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Figures

Figure 1
Figure 1. Medication use four months after laser and TURP procedures
TURP patients were more likely to be off medication after surgery than were laser patients regardless of medication use prior to surgery. Patients requiring new medication after surgery were split between use of alpha-blocker medication and antispasmodics. Patients continuing medication after surgery were commonly using alpha-blocker medications. Antispasmodic use was higher in laser treated patients and 5-alpha reductase inhibitor use was higher in TURP treated patients.
Figure 2
Figure 2. Efficacy of laser and TURP procedures
Patients off medical therapy and without failure by four months after surgery were examined for long-term efficacy of the procedures. The estimated probability of freedom from medical or surgical therapy at 3 years was 73.6% in the laser patients (95% CI, 71% to 76.2%) compared to 78.8% in the TURP patients (95% CI, 76.5% to 81.2%)
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References

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