Online Engagement with Surgical Treatments for Benign Prostatic Hyperplasia: Are Minimally Invasive Surgical Therapies Outpacing the Gold Standard? - Beyond the Abstract

Patients suffering from progressive symptoms of benign prostatic hyperplasia (BPH) increasingly turn to the internet for information on invasive and minimally invasive surgical therapies (MIST). Our study aimed to identify online articles accessed by patients seeking guidance on said options and to evaluate the quality and readability of their content.


Social media analytics tool Buzzumo was used to identify the most shared articles on Facebook, Twitter, Reddit, and Pinterest related to BPH surgical treatments from 2016 to 2021. The content quality was graded using the DISCERN tool; a questionnaire that assesses the quality of written information on treatment choices for a health problem. An online Automatic Readability Checker was used to evaluate the readability of the written transcripts. Lastly, Google Trends data was used to evaluate search term popularity for BPH procedures from 2016 to 2021. Google trends data and DISCERN ratings were analyzed with ANOVA and paired t-test, respectively.

A total of 18 articles met exclusion criteria accounting for 19,805 total engagements. Facebook was the most popular platform, accounting for 97% of total engagements. Half of the articles came from news organizations (50%) and zero articles came from a scientific peer reviewed journal (0%) Thirty-nine percent of identified articles were rated as low quality, 39% as moderate quality, and 22% as high quality using the DISCERN tool, with no significant difference among reviewer ratings (p = 0.0561). The areas with the lowest average scores were those addressing the risks of treatment, the risks of no treatment, and whether it provided support for shared decision making. The readability of the online articles ranged from a middle school level (grade 8) to a graduate student level (grade 15). The median reading level of all articles was 12th grade. Google Trends data revealed rising popularity of MIST such as Rezūm and Urolift, exceeding interest in more invasive procedures like Holmium laser enucleation of the prostate (HoLEP) and laser surgery. Transurethral resection of the prostate (TURP) remained popular with no significant difference between MIST and TURP on Google Trends (p = 3.46). The geographical distribution of search terms illustrates a widespread interest for Urolift and TURP from May 2016 to May 2021.

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The results of our study suggest the most accessed articles on BPH treatments have important shortcomings including risks of treatment and other available options for treatment. The readability analysis shows that article transcripts exceed the reading level of the average adult patient. This suggests that the content of the articles read, benefits, risks, and other available options alike is ineffective for individuals with low health literacy. We found that TURP has remained a popular procedure online, but there is a notable rising interest in MIST, especially Urolift. We suggest that patients will benefit if urologists direct them to sources of information and guidelines published by websites from the appropriate urological societies. The Urology Care Foundation, for example, offers evidence-based patient education materials on urologic health conditions and treatments at an average reading level and in multiple languages.

Written by: Mayra I. Lucas, Parris Diaz, Francisco J. Escobedo, Bree'ava J. Limbrick, Kymora B. Scotland

University of California Los Angeles David Geffen School of Medicine, Los Angeles, California; Charles Drew University of Medicine and Science, Los Angeles, California; UCLA Health System, Los Angeles, California; UCLA Health System, Los Angeles, California, United States; UCLA Health System, Los Angeles, California.

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