Which surgical procedure for BPH is associated with persistent medication use?

This study determined the percentage of men with benign prostatic hyperplasia (BPH) that still needed BPH medication after surgical therapy for lower urinary tract symptoms (LUTS). The authors concluded that laser enucleation of the prostate (LEP) had the lowest percentage of patients that still needed BPH medication.

Older men commonly experience prostate gland enlargement (benign prostatic hyperplasia). This leads to a blockage of urinary flow causing LUTS. LUTS involve symptoms such as trouble beginning urination, urine dribbling, and incomplete bladder emptying. Medication and lifestyle changes are normally used as first-line treatment for LUTS, while surgery is reserved for severe symptoms in patients that are unresponsive to medication. Long-term medication is undesirable since unwanted side effects can occur.

Several surgical therapies are available for BPH. The standard surgical therapy is called transurethral resection of the prostate (TURP) that involves trimming the excess prostate tissue blocking urine flow through the urethra (the tube that passes urine out of the bladder). Other surgical techniques for BPH include transurethral incision of the prostate (TUIP; the doctor cuts one or two small grooves in the area where the prostate and the bladder are connected to widen the urinary channel and allow urine to pass through more easily), laser vaporization of the prostate (LVP; a laser is used to heat up and vaporize excess prostate tissue blocking urine flow), laser enucleation of the prostate (LEP; a laser is used to cut out the excess prostate tissue), prostatic urethral lift (PUL; involves separating the enlarged prostate lobes to make the urethra wider, so that it is easier to urinate), and water vapor thermal therapy (WV; uses steam to vaporize excess prostate tissue).

It is not known how many patients still need BPH medications after undergoing a surgical procedure for BPH. 

This study involved 21,475 men with BPH on medical therapy who underwent surgery. 12,294 patients received TURP, 5290 patients had LVP, 1840 had LEP, 1308 had PUL, 397 received WV, and 346 patients had TUIP. Patients were followed for 2 years and were monitored for persistent need for BPH medications.

The use of medical therapy between 6 months to 2 years after surgery was lowest for patients who had LEP (38%). The percentages of patients who still needed medication for other procedures were 50% for WV, 61% for TURP, 63% for PUL, 65% for TUIP, and 66% for LVP.

The study found that after surgery over 50% of patients remained on medications and that 6 months to 2 years after surgery, LEP had the highest odds of stopping BPH medications.

This study used data from medical records. Patients were not randomized to each surgical procedure.