Elsevier

Urology

Volume 86, Issue 6, December 2015, Pages 1115-1122
Urology

Health Services Research
Use of Medical Therapy and Success of Laser Surgery and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

https://doi.org/10.1016/j.urology.2015.07.019Get rights and content

Objective

To assess the impact of surgery for benign prostatic hyperplasia (BPH) on use of medication (5-alpha reductase inhibitors, alpha blockers, antispasmodics), we assessed preoperative and postoperative medication utilization among surgically treated men.

Patients and Methods

Using the Truven Health Analytics MarketScan Commercial Claims Database, we defined a cohort of men aged <65 years who had surgical therapy for BPH with either transurethral resection of the prostate (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).

Results

We identified 6430 patients treated with either TURP (3096) or laser procedure (3334) for BPH. Presurgical antispasmodic use was associated with the highest risk of medication use at 4 months after surgery (odds ratio, 5.19; 95% confidence interval (CI), 3.16-8.53 vs no medication use before surgery). At 3 years after surgery, 6% (95% CI, 4%-8%) of laser-treated 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 preoperative antispasmodic use (hazard ratio, 2.49; 95% CI, 1.41-4.43).

Conclusion

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.

Section snippets

Patient Population

Using the Truven Health Analytics MarketScan Commercial Claims Database, a database of commercially insured patients, we identified a cohort of men aged <65 years who had surgical therapy for LUTS with either TURP or laser procedures from 2007 through 2009. This database contains all inpatient claims, outpatient claims, and medication data for patients while they have commercial insurance (from any insurance company) through their employer. Men aged older than 65 were not included from this

Results

We identified 6430 patients who were treated with either TURP (3096 patients) or a laser procedure (3334 patients) for BPH from 2007 to 2009 (Appendix 2). Patient age (P = .56), year of surgery (P = .93), and comorbidity (P = .05) were not significantly different between patients treated with TURP and laser therapy. We found no difference in the proportion of patients using BPH medication in the year before surgery (49% TURP, 48% laser); however, laser-treated patients used slightly more alpha

Comment

We found that surgery for BPH is successful in eliminating the need for medical therapy in over 75% of patients who use medication before surgery. However, up to 10% of patients who are not using medical therapy for LUTS before surgery are using medications after the procedure. A significant difference exists in the risk of continued and new medical therapy comparing TURP and laser procedures. However, medication use before surgical intervention had a stronger association with new or continued

Conclusion

Our results show a need for effective patient counseling about continued or new use of medical therapy after laser and TURP procedures. Antispasmodic medication use before surgery is most associated with new or continued medication use after surgery. However, most patients experience durable improvement after surgical intervention for BPH without need for subsequent medical or surgical intervention.

References (19)

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The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Financial Disclosure: The authors declare that they have no relevant financial interests.

Funding Support: This publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences.

Additional support for this publication was provided by the Washington University KL2 Career Development Awards Program (KL2 TR000450) and a National Institute of Diabetes and Digestive and Kidney Diseases Clinical Investigator Award (1K08DK097302-01A1).

The Center for Administrative Data Research is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences of the National Institutes of Health, and Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality.

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