Hypothesis / aims of study
Medical therapy for BPH can be effective for many patients, but may be hindered by side effects and lack of patient adherence. Surgical intervention can provide effective relief with a single treatment, but some patients may encounter post-operative complications. Here, we analyze large-scale real-world data to compare BPH-related procedures occurring with disease progression on daily medication vs post-operative procedures occurring in patients who received a surgical treatment for BPH.
Study design, materials and methods
A representative sample of US Medicare and commercial claims (IBM Watson) provided patient-level data on BPH patients who received treatment with medical therapy only (α-blockers, 5-ARIs, anti-cholinergics, β3-agonists, PDE5-inhibitors), or MIST or invasive surgery (MIST: UroLift PUL, Rezum WVTT; invasive surgery: TURP, PVP, Aquablation) from 2015-2021. CPT codes were used to identify BPH-related procedures occurring either after initiation of medical therapy or post-operatively following surgical treatment. ICD diagnosis codes were used to identify possible underlying causes for procedures in medical therapy patients. Cumulative incidence curves were created to calculate rates of BPH-related procedures through 12-months post-treatment.
The medical therapy cohort consisted of 203,504 patients with a mean treatment duration of 716d. Tamsulosin (n=75,698) and tadalafil (n=55,129) were the most commonly used medications. 5.5% of medical therapy patients experienced a BPH-related procedure after initiation of medication with a mean time of 121d to onset for any event. The most frequent BPH-related procedures in medical therapy patients were cystoscopy (n=9,920), catheterization (n=1,792), and bladder irrigation (n=975). Cystoscopies in medical therapy patients were associated with diagnoses of urinary retention and LUTS. The surgical cohort was comprised of traditional surgery (TURP (n=24,035), PVP (n=11,911), Aquablation (n=84)) and MIST (PUL (n=8,649), Rezum (n=1,944)) patients. Rates of post-operative BPH-related procedures were highest after Rezum (28%), lowest after PUL (17%), and comparable among traditional surgeries (PVP 22%, TURP 21%, Aquablaton 20%). For the surgery cohort, the top post-operative procedures were catheterizations, cystoscopies, and bladder irrigations.
Interpretation of results
This study evaluated rates of BPH-related procedures which occur after either initiation of medical therapy or post-operatively after surgery. Though rates of procedures are higher after surgery, nearly 6% of medical therapy patients undergo a BPH-related procedure, many of which are driven by diagnoses of urinary retention and LUTS. The most common procedures to occur after either initiation of medical therapy or surgery were cystoscopy, catheterization and bladder irrigation.