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Persistent use of medical therapy after surgery for lower urinary tract symptoms: a retrospective database analysis

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To determine how many men are able to remain off of medical therapy for lower urinary tract symptoms (LUTS) following surgery for benign prostatic obstruction (BPO).

Methods

The TriNetX Analytics Network was used to identify men who were taking medical therapy for BPO (at least one of: alpha-1 blockers, anticholinergics, B3 agonists, or 5-alpha-reductase inhibitors) and subsequently underwent surgery for BPO. They were then placed into one of six cohorts, classified based on the type of surgery they received: transurethral resection of the prostate (TURP), Laser vaporization of prostate (PVP), transurethral incision of the prostate (TUIP), prostatic urethral lift (PUL), water–vapor thermal therapy (WV), or Laser enucleation of the prostate (LEP). Our primary outcome was persistent use of medical therapy at 6-months–2-years postoperatively. Secondary outcome was surgical retreatment by 2 years postoperatively. Propensity-score matching (PSM) was used to control for various risk factors for lower urinary tract symptoms (LUTS).

Results

A total of 21,475 men were identified who were on medical therapy and subsequently underwent surgery, which included 12,294 TURP, 5290 PVP, 397 WV, 1308 PUL, 346 TUIP, and 1840 LEP. Medication use between 6 months and 2 years after surgery was 38% for LEP, 50% for WV, 61% for TURP, 63% for PUL, 65% for TUIP and 66% for PVP. All surgical modalities had higher odds of using medications when compared to LEP (p < 0.001). This remained significant after PSM for 9 potentially confounding variables.

Conclusion

A large percentage of men continue medical therapy after surgery for BPO. Amongst multiple surgical modalities available, LEP appears to have the highest rates of medication discontinuation after surgery. In men who wish to avoid medications or who have cardiac risk factors, a discussion with their urologist to select the best option to minimize medical therapy should occur.

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References

  1. Parsons JK et al (2020) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline amendment 2020. J Urol 204(4):799–804

    Article  Google Scholar 

  2. Abrams P (2021) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline amendment 2020. Letter. J Urol 205(3):938

    Article  Google Scholar 

  3. Campbell RA, Gill BC (2020) Medication discontinuation following transurethral prostatectomy: an unrecognized effectiveness measure? Curr Urol Rep 21(12):61

    Article  Google Scholar 

  4. Sabharwal NC et al (2019) Comparative effectiveness of transurethral prostate procedures at enabling urologic medication discontinuation: a retrospective analysis. Urology 134:192–198

    Article  Google Scholar 

  5. Worthington J et al (2020) Thulium laser transurethral vaporesection versus transurethral resection of the prostate for benign prostatic obstruction: the UNBLOCS RCT. Health Technol Assess 24(41):1–96

    Article  Google Scholar 

  6. McVary KT, Gittelman MC, Goldberg KA et al (2021) Final 5-Year Outcomes of the Multicenter Randomized Sham-Controlled Trial of a Water Vapor Thermal Therapy for Treatment of Moderate to Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. J Urol. 206(3):715–724. https://doi.org/10.1097/JU.0000000000001778

    Article  PubMed  Google Scholar 

  7. Strope SA et al (2015) Use of medical therapy and success of laser surgery and transurethral resection of the prostate for benign prostatic hyperplasia. Urology 86(6):1115–1122

    Article  Google Scholar 

  8. Gray SL et al (2015) Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med 175(3):401–407

    Article  Google Scholar 

  9. Welk B et al (2017) Association of suicidality and depression with 5alpha-reductase inhibitors. JAMA Intern Med 177(5):683–691

    Article  Google Scholar 

  10. Lusty A et al (2021) Cardiac failure associated with medical therapy of benign prostatic hyperplasia: a population based study. J Urol 205(5):1430–1437

    Article  Google Scholar 

  11. Taquet M et al (2021) Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry 8(2):130–140

    Article  Google Scholar 

  12. Michalak J, Tzou D, Funk J (2015) HoLEP: the gold standard for the surgical management of BPH in the 21(st) century. Am J Clin Exp Urol 3(1):36–42

    PubMed  PubMed Central  Google Scholar 

  13. Gilling PJ et al (2012) Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int 109(3):408–411

    Article  Google Scholar 

  14. Calogero AE et al (2019) Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. Aging Male 22(1):12–19

    Article  Google Scholar 

  15. Hakenberg OW et al (2001) Is there a relationship between the amount of tissue removed at transurethral resection of the prostate and clinical improvement in benign prostatic hyperplasia. Eur Urol 39(4):412–417

    Article  CAS  Google Scholar 

  16. Palaniappan S et al (2016) Early outcome of transurethral enucleation and resection of the prostate versus transurethral resection of the prostate. Singap Med J 57(12):676–680

    Article  Google Scholar 

  17. Tan AH et al (2003) A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol 170(4 Pt 1):1270–1274

    Article  CAS  Google Scholar 

  18. Martos M et al (2021) Impact of perioperative factors on nadir serum prostate-specific antigen levels after holmium laser enucleation of prostate. BJUI Compass 2(3):202–210

    Article  Google Scholar 

  19. Large T et al (2016) MP42-09 durable symptom improvement after holmium laser enucleation of the prostate (HOLEP): analyzing outcomes at ten years in over 100 men. J Urol 195(4S):e572–e572

    Google Scholar 

  20. Garden EB, Shukla D, Ravivarapu KT et al (2021) Rezum therapy for patients with large prostates (≥ 80 g): initial clinical experience and postoperative outcomes. World J Urol 3:1–8. https://doi.org/10.1007/s00345-020-03548-7

  21. Han HH et al (2014) Factors associated with continuing medical therapy after transurethral resection of prostate. Urology 84(3):675–680

    Article  Google Scholar 

  22. Campbell J et al (2019) The utilization of benign prostatic hyperplasia and bladder-related medications after a transurethral prostatectomy. Urology 130:126–131

    Article  Google Scholar 

  23. Sonksen J et al (2015) Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol 68(4):643–652

    Article  Google Scholar 

  24. Roehrborn CG et al (2017) Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. Study. Can J Urol 24(3):8802–8813

    PubMed  Google Scholar 

  25. McVary KT, Roehrborn CG (2018) Three-year outcomes of the prospective, randomized controlled Rezūm System study: convective radiofrequency thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Urology 111:1–9

    Article  Google Scholar 

  26. Roehrborn CG et al (2017) Convective thermal therapy: durable 2-year results of randomized controlled and prospective crossover studies for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. J Urol 197(6):1507–1516

    Article  Google Scholar 

  27. Andriole GL et al (2010) Effect of dutasteride on the risk of prostate cancer. N Engl J Med 362(13):1192–1202

    Article  CAS  Google Scholar 

  28. Coupland CAC et al (2019) Anticholinergic drug exposure and the risk of dementia: a nested case–control study. JAMA Intern Med 179(8):1084–1093

    Article  Google Scholar 

  29. Stuart EA, Bradshaw CP, Leaf PJ (2015) Assessing the generalizability of randomized trial results to target populations. Prev Sci 16(3):475–485

    Article  Google Scholar 

  30. Franklin JM et al (2021) Emulating randomized clinical trials with nonrandomized real-world evidence studies: first results from the RCT DUPLICATE initiative. Circulation 143(10):1002–1013

    Article  Google Scholar 

  31. Quan H et al (2008) Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database. Health Serv Res 43(4):1424–1441

    Article  Google Scholar 

  32. Yap TL et al (2007) The relationship between objective frequency-volume chart data and the I-PSS in men with lower urinary tract symptoms. Eur Urol 52(3):811–818

    Article  Google Scholar 

  33. Foo KT (2019) What is a disease? What is the disease clinical benign prostatic hyperplasia (BPH)? World J Urol 37(7):1293–1296

    Article  Google Scholar 

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Acknowledgements

Research was supported by Acerus Pharmaceuticals in the form of an educational grant used to access the TriNetX database. Acerus Pharmaceuticals was not involved in the planning, design, writing or any other aspect of this project.

Funding

Research was supported by Acerus Pharmaceuticals in the form of an educational grant used to access the TriNetX database. Acerus Pharmaceuticals was not involved in the planning, design, writing or any other aspect of this project.

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Authors and Affiliations

  1. Department of Urology, University of Miami, 1150 NW 14th St, Suite 309, Miami, FL, 33136, USA

    Jesse Ory, Nicholas Smith, Hemendra Shah & Ranjith Ramasamy

  2. University of Miami Miller School of Medicine, Miami, FL, USA

    Sirpi Nackeeran & Quinn Rainer

  3. Department of Urology, Dalhousie University, Halifax, NS, Canada

    Jesse Ory

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  1. Jesse Ory
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  2. Sirpi Nackeeran
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  3. Quinn Rainer
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  4. Nicholas Smith
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  5. Hemendra Shah
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  6. Ranjith Ramasamy
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Contributions

JO: manuscript writing/editing, protocol/project development. SN: data collection, data analysis. QN: manuscript writing. NS: manuscript writing, project development. HS: project development, supervision. RR: project development, supervision.

Corresponding author

Correspondence to Ranjith Ramasamy.

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All data in TriNetX are deidentified, thus ethics is not applicable.

Informed consent

All data in TriNetX are deidentified, thus informed consent is not applicable.

Research involving human participants and/or animals

See above. Not applicable for animals. Re: human participants, ethics/consent not applicable.

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Ory, J., Nackeeran, S., Rainer, Q. et al. Persistent use of medical therapy after surgery for lower urinary tract symptoms: a retrospective database analysis. World J Urol 40, 169–175 (2022). https://doi.org/10.1007/s00345-021-03819-x

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  • DOI: https://doi.org/10.1007/s00345-021-03819-x

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