Comparative Effectiveness of Benign Prostate Enlargement Interventions at Facilitating Urologic Medication Discontinuation

Large, comparative effectiveness analyses of transurethral prostate procedures (TUPPs) enabling discontinuation of urologic medications (Rx) are lacking. This study tested the hypothesis that tissue-eliminating procedures confer greater medication discontinuation rates than tissue-necrosing procedures.

All TUPPs in a large tertiary system from 2001-2016 were identified. Demographics, procedure type, and urologic Rx use preoperatively, 3-12 months postoperatively, and over 12 months postoperatively were collected. Tissue-eliminating procedures included transurethral resection (TURP) and laser photovaporization (PVP), tissue-necrosing procedures were microwave (TUMT) and radiofrequency needle ablation (TUNA), with simple prostatectomy (SP) included as a gold-standard comparator. Rx were "discontinued" if no longer an active prescription starting 3 months postoperatively and were "resumed" if ever active following this. Rx were "initiated" if active 3 months or more postoperatively and not active preoperatively.

A total of 5150 TUPPs were analyzed (Table 1). Mean age ranged from 69.1-71.8 years across procedures. Preoperative Rx significantly differed across procedures, except Beta-3 agonist. Alpha blockers were the most common and Beta-3 agonist were the least common Rx preoperatively. Tissue-eliminating TUPPs had greater rates of Rx discontinuation than tissue-necrosing procedures, while the latter had the highest Rx resumption and initiation rates. Alpha blocker and 5-alpha reductase inhibitor discontinuation, resumption, and initiation rates significantly differed across procedures, whereas all but anticholinergic discontinuation rates did, too. Only Beta-3 agonist initiation differed across procedures. Rates of Rx discontinuation were greatest for SP relative to TUPPs and rates of Rx resumption and initiation were lowest for SP compared to TUPPs, as well.

Gill Comparative Effectiveness of Benign Prostate Enlargement Interventions

Relative to tissue-necrosing transurethral prostate procedures, tissue-eliminating procedures achieved superior rates of urologic medication discontinuation, resumption, and de novo initiation. Simple prostatectomy outperformed all transurethral procedures in these regards.

Authors: Bradley Gill, Navin Sabharwal, James Ulchaker, Khaled Fareed, Daniel Shoskes, Cleveland, OH

MP73-09 Comparative Effectiveness of Benign Prostate Enlargement Interventions at Facilitating Urologic Medication Discontinuation, Gill, Bradley et al. The Journal of Urology, Volume 199, Issue 4, e994

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