The incidence and risk factors for persisting pharmacotherapy following surgical treatment of benign prostatic obstruction (BPO) remain unclear.
To evaluate the evidence on persisting pharmacotherapy of lower urinary tract symptoms (LUTS) following surgical treatment of BPO.
A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist (PROSPERO ID CRD42022310598). PubMed and EMBASE databases were searched in February 2022, with an updated search in October 2022. Studies evaluating pharmacotherapy in men aged >18 yr following surgical treatment of BPO were included.
Overall, ten nonrandomized studies and one post hoc analysis of two randomized controlled trials were included. The incidence of persisting medical treatment or medical retreatment varied strongly between time points and investigated surgical techniques. Among the investigated techniques, most data were available for transurethral resection of the prostate (TURP). Persistence of pharmacotherapy after TURP at 6 mo ranged from 8.7% to 57% for the use of alpha-blockers. The use of 5-alpha reductase inhibitors after TURP ranged from 5.5% at 6 mo to 19% at 6-24 mo, whereas the use of antimuscarinics ranged from 3.4% to 28.1% at 6 mo. Data on initiation of pharmacotherapy after TURP also differed between study and type of medication. At 12 yr, the use of alpha-blockers after TURP ranged from 12% to 38%. The risk factors associated with medication after BPO surgery were age, history of diabetes mellitus, history of cerebrovascular accident, preoperative medication use, as well as surgical techniques other than laser enucleation of the prostate.
Pharmacotherapy for LUTS is common after BPO surgery. The outcomes following different surgical techniques are heterogeneous, with limited data from randomized controlled trials. Future studies on surgical treatment of BPO should include the use of LUTS-related pharmacotherapy after BPO surgery as a secondary endpoint.
In the present systematic review, we investigated the risk of ongoing or novel therapy with drugs following surgery for benign prostate enlargement. We found that a non-negligible proportion of men will need to take drug therapy after surgery. Certain risk factors can be identified, which are associated with a higher risk of drug therapy after surgery.
European urology focus. 2023 Sep 25 [Epub ahead of print]
Malte Rieken, Cosimo de Nunzio, Jean-Nicolas Cornu, Ranjith Ramasamy, Vincent Misrai, Sachin Malde, Matthias Oelke, Mauro Gacci, Stephan Madersbacher
alta uro AG, Basel, Switzerland; University of Basel, Basel, Switzerland. Electronic address: ., U.O.C. di Urologia, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy., Charles Nicolle University Hospital, Rouen Cedex, France., University of Miami Health System, Miami, FL, USA., Clinique Pasteur, Toulouse, France., Guy's and St Thomas' NHS Foundation Trust, London, UK., Department of Urology, Prostate Center North-West, St. Antonius-Hospital, Gronau, Germany., Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Department of Urology, Klink Favoriten, Vienna, Austria.