TOPLINE

Among patients who were naive to bladder medications and underwent surgery for benign prostatic hyperplasia (BPH), de-novo initiation of anticholinergic or beta-3 agonist (ACh/B3a) therapy between 3 and 12 months after surgery varied by procedure type. Laser photovaporization (PVP) was associated with a higher risk for initiation of medication use than transurethral resection of the prostate (TURP).

METHODOLOGY

• Researchers conducted a cohort study utilizing administrative claims data from the Michigan Value Collaborative to determine how frequently patients initiated de novo ACh/B3a after surgery for BPH, analyzed by the type of procedure.
• A total of 11,519 patients (median age, 72 years; 79% White) with no exposure to ACh/B3a medications in the 6 months preceding surgery, who underwent BPH surgery between July 2017 and December 2022, were included.
• The procedures analyzed included TURP, PVP, laser enucleation of the prostate, robotic waterjet therapy, water vapor thermal therapy, transurethral microwave thermotherapy, and others.
• The primary outcome was initiation of ACh/B3a therapy, defined as the prescription fill for an anticholinergic (darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, or trospium) or beta-3 agonist (mirabegron or vibegron) first received between 3 and 12 months after surgery.
• Patient- and procedure-related factors that were associated with initiation of medications were also assessed.

TAKEAWAY

• Rates of ACh/B3a initiation varied by the type of procedure; of the procedures with available data, cumulative incidence at 12 months ranged from 5.7% for transurethral microwave thermotherapy to 11% for PVP.
• On multivariable analysis, only PVP was independently associated with an increased risk for ACh/B3a initiation compared with TURP (hazard ratio [HR], 1.49; 95% CI, 1.25-1.79); all remaining procedures showed no significant difference in initiation risk relative to TURP.
• Prior use of BPH medications was associated with higher risk for ACh/B3a initiation (HR, 1.69; P < .001), as was use of anticoagulation before surgery (HR, 1.36; P < .001), whereas dependence on a catheter before surgery was associated with a reduced risk (HR, 0.71; P = .001).
• For most procedures, initiation of ACh/B3a occurred predominantly between 3 and 6 months after surgery; neither age nor the burden of comorbidities was significantly associated with initiation.

IN PRACTICE

"[The study] findings provide real-world, multi-procedure estimates of de-novo ACh/B3a medication initiation after BPH surgery, offering practical benchmarks for patient counseling in an era of expanding procedural options," the authors wrote. "[T]hese findings suggest that ACh/B3a initiation after PVP may reflect procedure-driven irritative symptoms rather than true de-novo storage LUTS. This distinction has direct counseling implications, where patients considering PVP should be informed that postoperative storage symptoms are more common with this approach," they added.

SOURCE

The study was led by Michael Uy of the Department of Urology at the University of Michigan, Ann Arbor. It was published online on October 22 in The Journal of Urology.

LIMITATIONS

Clinical details at the individual level, such as the size of the prostate, urinary flow before the procedure, volume retained after voiding, severity of storage symptoms at baseline, and the reason for undergoing surgery, were lacking. Whether prescriptions were prompted by patient symptoms, clinician preference, or routine postoperative practice could not be determined, and recorded fills may not reflect actual consumption of the medication.

DISCLOSURES

Blue Cross Blue Shield of Michigan and Blue Care Network provided support for Michigan Urological Surgery Improvement Collaborative and Michigan Value Collaborative as part of the Blue Cross Blue Shield of Michigan Value Partnerships program. Several authors reported serving as consultants and/or receiving investigator funding from various companies including Boston Scientific, Olympus, Blue Cross Blue Shield of Michigan, and other sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.