Impact of Endoscopic Bladder Outlet Procedures on Medical and Surgical Retreatment: A Large Population Analysis

Purpose: Many men undergo operation for benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Although most procedures relieve symptoms, some patients experience recurrence or persistence. This study explores rates of and factors contributing to medical and surgical retreatment after index BPH procedure. Methods: This longitudinal, retrospective, population-based cohort study used MarketScan commercial insurance claims data. From 2009, men with BPH/LUTS diagnosis were evaluated for medical and surgical retreatment after index operation. Index procedures included holmium laser enucleation of the prostate (HoLEP), laser ablation of the prostate, and transurethral resection of the prostate grouped as traditional procedures, whereas transurethral microwave thermotherapy (TUMT), transurethral needle ablation, water vapor thermal therapy, and prostatic urethral lift (PUL) were minimally invasive surgical therapies (MISTs). Multivariable Cox hazard models (p < 0.05) were used to determine factors associated with retreatment after index procedure. Results: We evaluated 10,938 men with median age at diagnosis of 58 years (minimum-maximum 35-65). Five-year surgical retreatment rates were highest for TUMT and PUL (24.5% and 22.3%) and lowest for HoLEP (7%; p < 0.001). One-year medical retreatment rates with bladder outlet medications (i.e., alpha-blockers, 5-alpha reductase inhibitors) were higher after MIST compared with traditional procedures (42.9% vs 27.3%; p < 0.001). Conclusion: Surgical and medical retreatment rates are higher than previously reported in clinical trials. MIST procedures and older age were predictive of both medical and surgical retreatment after index operation. HoLEP had the lowest rate of retreatment compared with TUMT and PUL, which had the highest.