The Impact of MISTs on Australian BPO Surgical Trends

Background/Objectives: To evaluate the impact of Minimally Invasive Surgical Therapies (MISTs) on Australian trends for surgeries treating lower urinary tract symptoms (LUTSs) caused by benign prostatic obstruction (BPO). The recent adoption of the prostatic urethral lift (PUL) and water vapour thermal therapy (such as Rezum) into the Medicare Benefits Scheme (MBS) item schedule on the 1 March 2024 has likely had an impact on Australian surgical trends and we aim to describe their impact on the use of other commonly offered BPO-related surgeries. Methods: This study analyses population-adjusted rates of BPO-related surgeries in Australia from January 2004 to September 2024 using publicly available online Medicare Statistics and Census Data. Independent t-tests and significance levels were calculated to compare procedure rates before and after the introduction of PUL and Rezum in March 2024. Results: In total, 301,648 BPO surgical procedures were claimed under MBS in Australia from January 2004 to September 2024, with transurethral resection of the prostate (TURP) being the most common (78%). Procedure rates increased overall with significant shifts in treatment preference: TURP rates have steadily declined in Australia after peaking in 2009 (123.4 per 100,000 adult men), whilst photo-selective vaporisation of the prostate (PVP) and enucleation have risen. Following the introduction of PUL and Rezum on 1 March 2024, enucleation and simple prostatectomy rates increased, while Transurethral needle ablation (TUNA) and urethral and prostatic prosthesis (UPP) decreased. TURP rates were unaffected. Conclusions: Throughout the past two decades, BPO surgical trends in Australia have shifted, with TURP declining as PVP and enucleation have risen. The 2024 MBS listing for PUL and Rezum has boosted their uptake whilst reducing both TUNA and UPP claims. Simple prostatectomy rates remained stable.