Endoscopic Outlet Surgery vs Medical Therapy for Benign Prostatic Hyperplasia: Impact on Incident Mood Disorders

To compare the incidence of new-onset depression, anxiety, suicidal ideation, and bipolar disorder among men with BPH treated with endoscopic outlet surgery vs medical management.

Using the TriNetX Research Network, we conducted a retrospective cohort study with 2 parallel 1:1 propensity score-matched (PSM) analyses comparing endoscopic outlet surgery (TURP, GreenLight PVP, laser enucleation of the prostate, or Aquablation) to (1) third-generation alpha-blocker monotherapy and (2) combination alpha-blocker/5α-reductase inhibitor therapy. After exclusion and matching on demographics, comorbidities, and healthcare utilization, 10,048 matched pairs were included.

Surgery was associated with significantly lower rates of depression at 1 year (RR 0.68, 95% CI 0.55-0.84), 3 years (RR 0.76, 95% CI 0.66-0.87), and 5 years (RR 0.81, 95% CI 0.72-0.92) compared to alpha-blocker monotherapy; anxiety was similarly reduced at 1 year (RR 0.74, 95% CI 0.61-0.90), 3 years (RR 0.79, 95% CI 0.69-0.90), and 5 years (RR 0.79, 95% CI 0.71-0.89). Compared to combination therapy, surgery demonstrated greater protective effects for depression (5-year RR 0.70, 95% CI 0.62-0.79) and anxiety (5-year RR 0.77, 95% CI 0.69-0.86). No differences were observed for suicidal ideation or bipolar disorder. In sensitivity analyses restricted to those with ≥3 prescriptions of tamsulosin monotherapy or ≥3 prescriptions each of tamsulosin and finasteride, the protective effects of surgery were further strengthened for both depression and anxiety across all time points (all P <.0001).

Endoscopic outlet surgery is associated with significantly lower risk of incident depression and anxiety compared to both medical management strategies over 5 years of follow-up.