Predictors of Medication Cessation After Benign Prostatic Hyperplasia Procedures

PURPOSE: Medication cessation is an important motivator for patients undergoing benign prostatic hyperplasia (BPH) surgery; however, evidence on this topic remains limited. We evaluated rates and probabilities of BPH and overactive bladder (OAB) medication cessation in a statewide cohort. MATERIALS AND METHODS: Using Michigan statewide claims data (2017-2022) from the Michigan Value Collaborative, patients who underwent BPH surgery with pre-existing BPH or OAB medications were identified. Procedures were categorized as (1) transurethral surgery, including transurethral resection of the prostate (TURP), laser photovaporization (PVP), robotic waterjet therapy (RWJT), and laser enucleation of the prostate (LEP); (2) minimally invasive surgical therapies (MISTs), including water vapor thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic artery embolization (PAE), and transurethral microwave thermotherapy (TUMT); and (3) simple prostatectomy (SP). Medication cessation was defined as no refills between 181 and 365 days postoperatively. Multivariable logistic regression estimated procedure-specific probabilities of cessation. RESULTS: Among 12,633 patients with continuous pharmacy enrollment, 8628 (68%) were prescribed BPH medications and 933 (7%) were prescribed OAB medications preoperatively. Medication cessation occurred in 61% and 62% of the BPH and OAB cohort, respectively. Predicted probabilities of BPH medication cessation were highest for LEP and SP (≥ 84%) and lowest for MISTs (< 60%). No statistically significant differences in OAB medication cessation were found across procedures. CONCLUSIONS: In this real-world, statewide cohort, BPH medication cessation varied by procedure type. Transurethral surgeries and SP were associated with higher BPH medication cessation rates, while minimally invasive surgical therapies had lower rates. These findings provide practical estimates to inform shared decision-making and counseling when considering BPH interventions.