Persistent use of medical therapy after surgery for lower urinary tract symptoms: a retrospective database analysis

Purpose: To determine how many men are able to remain off of medical therapy for lower urinary tract symptoms (LUTS) following surgery for benign prostatic obstruction (BPO). Methods: The TriNetX Analytics Network was used to identify men who were taking medical therapy for BPO (at least one of: alpha-1 blockers, anticholinergics, B3 agonists, or 5-alpha-reductase inhibitors) and subsequently underwent surgery for BPO. They were then placed into one of six cohorts, classified based on the type of surgery they received: transurethral resection of the prostate (TURP), Laser vaporization of prostate (PVP), transurethral incision of the prostate (TUIP), prostatic urethral lift (PUL), water–vapor thermal therapy (WV), or Laser enucleation of the prostate (LEP). Our primary outcome was persistent use of medical therapy at 6-months–2-years postoperatively. Secondary outcome was surgical retreatment by 2 years postoperatively. Propensity-score matching (PSM) was used to control for various risk factors for lower urinary tract symptoms (LUTS). Results: A total of 21,475 men were identified who were on medical therapy and subsequently underwent surgery, which included 12,294 TURP, 5290 PVP, 397 WV, 1308 PUL, 346 TUIP, and 1840 LEP. Medication use between 6 months and 2 years after surgery was 38% for LEP, 50% for WV, 61% for TURP, 63% for PUL, 65% for TUIP and 66% for PVP. All surgical modalities had higher odds of using medications when compared to LEP (p < 0.001). This remained significant after PSM for 9 potentially confounding variables. Conclusion: A large percentage of men continue medical therapy after surgery for BPO. Amongst multiple surgical modalities available, LEP appears to have the highest rates of medication discontinuation after surgery. In men who wish to avoid medications or who have cardiac risk factors, a discussion with their urologist to select the best option to minimize medical therapy should occur.