NS-AUA 2024 Annual Meeting Abstracts – Best Practices, Benign Disease

Introduction: Patients electing benign prostatic hyperplasia (BPH) surgery may wish to cease BPH medical therapy, though some patients may continue or begin medication post-surgery to treat residual symptoms.In this large-scale healthcare claims analysis, we produce rates of continued and de novo BPH medical therapy following transurethral resection of the prostate (TURP), GreenLight photoselective vaporization (PVP), and UroLift prostatic urethral life (PUL) procedures.Methods: Patients with 1 year of followup who underwent outpatient TURP (n=20 319), GreenLight (n=10 517), or PUL (n=5793) were identified within this representative sample of 2015-2021 Medicare and commercial claims.Linking pharmaceutical claims to outpatient surgical claims produced rates of continuous and de novo use of alpha-blockers, 5ARI, or combination therapy; only patients with 2 instances of medical therapy prescriptions following BPH surgery were included.Perioperative medication usage was defined as 2 medication prescriptions within three months only and not beyond; prolonged use was assessed through one and five years postoperative.Results: Rates of perioperative medical therapy were similar between all treatments.The rates of continued medication use following PUL, TURP, and PVP were 2.5%, 4.0% and 4.2%, respectively.De novo use was low after all therapies; lowest for PUL (0.5%) and similar between TURP (0.9%) and PVP (1.0%).The total one-year medical therapy rate was lowest for PUL (3.9%, TURP 6.1%, PVP 6.5%).Rates of continued and de novo use were: PUL (8.4% continued, 1.0% de novo), TURP (7.0% continued, 2.0% de novo), and PVP (7.2% continued, 1.7% de novo).The total combined five-year medical therapy rate was similar between all three therapies: PUL (10.3%),TURP (10.2%), and PVP (10.2%).Alpha-blockers were the leading BPH drug class utilized through one and five years post-PUL, TURP, and PVP.Conclusions: Post-surgery medication use is an important, yet relatively unexplored, element of the BPH patient journey.Rates of medication use through one year were higher following TURP and PVP compared to PUL, and were equivalent at five years.This may indicate that in a real-world setting, TURP and PVP patients could have more advanced disease that doesn't fully respond to the benefits of the selected intervention.The five-year real-world rate of medication usage for PUL in this analysis is similar to the rate demonstrated in the LIFT pivotal trial (10.3% vs. 10.7%LIFT).