Use of Medical Therapy and Success of Laser Surgery and TURP for BPH

To assess the impact of surgery for BPH on use of medication (5-ARIs, alpha blockers, antispasmodics), we assessed pre- and post-operative medication utilization among surgically treated men.

Using the Truven Health Analytics MarketScan® Commercial Claims Database, we defined a cohort of men < 65 years of age who had surgical therapy for BPH with either TURP or laser procedures from 2007 through 2009.

Primary outcomes included freedom from medical or surgical intervention by 4 months after surgery (chi-square and multivariable logistic regression) and subsequent use of medical or surgical intervention in initial responders (Kaplan-Meier and multivariable Cox regression).

We identified 6430 patients treated with either TURP (3096) or laser procedure (3334) for BPH. Pre-surgical antispasmodic use was associated with the highest risk of medication use at 4 months after surgery (OR 5. 19; CI 3. 16 to 8. 53 versus no medication use prior to surgery). At three years after surgery, 6% (95% CI 4-8%) of laser and 4% (95% CI 2-5%) of TURP treated patients had repeat surgical intervention, and both laser and TURP treated patients had an estimated new use of medication rate of 22% (95% CI 18-25% laser and 20-25% TURP). The strongest predictor of intervention after surgery was pre-operative antispasmodic use (HR 2. 49; 95% CI 1. 41 to 4. 43).

Our results show a need for effective patient counseling about continued or new use of medical therapy after laser and TURP procedures. However, most patients experience durable improvement after surgical intervention for BPH.

Urology. 2015 Sep 12 [Epub ahead of print]

Seth A Strope, Joel Vetter, Sean Elliott, Gerald L Andriole, Margaret A Olsen

Division of Urology, Department of Surgery, Washington University, Saint Louis MO.  Division of Urology, Department of Surgery, Washington University, Saint Louis MO. , Department of Urology, University of Minnesota, Minneapolis, MN. , Division of Urology, Department of Surgery, Washington University, Saint Louis MO. , Department of Internal Medicine, Washington University, Saint Louis MO.

PubMed

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