A Large-Scale Real-World Analysis: BPH-Related Procedures Associated with Medical Therapy Compared to Traditional Surgery and MIST
Ronald P. Kaufman, Jr., MD1, Claus Roehrborn, MD2, Daniel Rukstalis, MD3, Dean Elterman, MD4, Steven Kaplan, MD5.
1Albany Medical College, Albany, NY, USA, 2UT Southwestern, Dallas, TX, USA, 3Carilion Clinic, Roanoke, VA, USA, 4University of Toronto, Toronto, ON, Canada, 5Icahn School at Mount Sinai, New York, NY, USA.
BACKGROUND: Effective medical therapy for BPH may be hindered by lack of patient adherence while surgical intervention can provide relief with a single treatment. Here, we analyze large-scale real-world data to compare BPH-related procedures occurring with disease progression on daily medication vs those with surgical treatment for BPH. METHODS: A representative sample of US Medicare and commercial claims (IBM Watson) provided patient-level data on BPH patients who received medical therapy only (α-blockers, 5-ARIs, anti-cholinergics, β3-agonists, PDE5-inhibitors), or outpatient surgery (TURP, PVP, Aquablation, UroLift PUL, Rezum WVTT) from 2015-2021. CPT codes identified BPH-related procedures occurring either after initiation of medical therapy or post-operatively following surgical treatment. ICD diagnosis codes identified possible underlying causes for procedures in medical therapy patients. Cumulative incidence curves demonstrate BPH-related procedure rates through 12-months post-treatment. RESULTS: The medical therapy cohort consisted of 203,504 patients and had 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 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. CONCLUSIONS: As BPH disease progresses, ~6% of medical therapy patients undergo procedures within 1 year of initiating medication use. Post-operative procedure rates were lowest following PUL and similar between PVP and TURP. 
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