Comparative Effectiveness of Benign Prostate Enlargement Interventions at Facilitating Urologic Medication Discontinuation - Beyond the Abstract

This study compared rates of urologic medication discontinuation after various Benign Prostatic Hypertrophy (BPH) procedures. Overall, procedures that immediately eliminated or removed excess prostate tissue (i.e. transurethral resection or laser vaporization) were better able to get men off of their urologic medications than procedures that induced a delayed necrosis (i.e. microwave therapy or needle ablation) in the prostate. Not surprisingly, suprapubic prostatectomy was the most effective procedure in facilitating urologic medication discontinuation.

The study was conducted by reviewing all BPH procedures within the Cleveland Clinic electronic medical record system. In all, some 5,150 procedures were identified for analysis. Demographics of the patients undergoing BPH procedures were as expected, with rates of pre-operative alpha-blocker use and 5-alpha-reductase use ranging from 37% to 80% across the various procedure types. Within the first year of tissue-eliminating surgery, up to 86% of men were able to discontinue these medications. Around 11% to 12% of men who had discontinued a medication eventually resumed it over this same period. 

In the long term, beyond the first year, the majority of men who underwent tissue-eliminating procedures remained off their medications. Specifically, for 5-alpha reductase inhibitors and alpha-blockers, anywhere from 66% to 76% of men were able to eliminate their use. Similarly, such procedures enabled 53% to 62% of men to come off of all medications. As can be expected, long-term rates of medication discontinuation were best after suprapubic prostatectomy, despite this procedure having an 8.3% rate of anticholinergic initiation in the short term, the highest rate of all procedures from 3-6 months postoperatively. 

This study provides an initial insight into the comparative effectiveness of BPH procedure at enabling men to discontinue urologic medication use. The results generally support what has been anecdotally suspected for years by urologists – procedures that remove excess prostate tissue are more effective than those that downsize it through delayed necrosis. Further work in this area is warranted, as healthcare costs continue to rise and such comparative studies may provide insight into the most effective means of treatment, if not only supply valuable information for physicians to counsel their patients. As newer office-based therapies continue to take hold, they should be incorporated into similar analyses.

Written by: Bradley C Gill, MD, MS, Department of Urology, Glickman Urological and Kidney Institute, Urologic Surgery, Cleveland Veterans Affairs Medical Center, Cleveland Clinic Lerner College of Medicine, Education Insititute
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