Google infodemiology and temporal trends in benign prostatic hyperplasia surgery in Australia

To contextualise the national population-based temporal surgical trends in the management of benign prostatic hyperplasia (BPH) in Australia.

Google Trends (GT) was used to analyse the level of patients' online interest in various surgical options for the treatment of BPH. Analysis of variance was performed and the average rates of change in GT popularity score was calculated for the period from 1 January 2010 to 31 October 2022. Data regarding surgical volume were extracted from the Medicare Benefits Schedule and the Australian Institute of Health and Welfare databases, and population-adjusted rates of BPH procedures performed were calculated accordingly.

The level of online interest in Australia was highest for transurethral resection of the prostate (TURP) and population data also showed that TURP remained the most utilised procedure across the study period. Nationwide, there was an increased uptake of photovaporisation of the prostate, accounting for 7.6% of BPH procedures in 2020-2021, with correspondingly lower rates of TURP and simple prostatectomies performed. Holmium laser enucleation of the prostate (HoLEP) appeared to be underutilised and had the lowest mean popularity score, while prostatic urethral lift (PUL) and transurethral water vapour ablation (TUWA) showed strong uptake in the more recent years. The average rates of change were highest for TURP at +1.59/year (P < 0.001), followed by PUL at +0.56/year (P < 0.001) and TUWA at +0.50/year (P = 0.004), while the lowest was for HoLEP at +0.09/year (P = 0.116).

Differences were found between GT analysis and actual BPH procedures performed at a population level. This study highlights that clinicians need to adapt and provide better patient counselling to ensure a shared decision-making process when choosing the treatment procedure for BPH/male LUTS.