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

Area of Science:

• Urology
• Psychiatry
• Health Services Research

Background:

• Benign prostatic hyperplasia (BPH) is a common condition in aging men.
• Treatment options for BPH include medical management and surgical interventions.
• The psychological impact of BPH treatments is an area of ongoing investigation.

Purpose of the Study:

• To compare the incidence of new-onset depression, anxiety, suicidal ideation, and bipolar disorder.
• To evaluate outcomes in men with BPH treated with endoscopic outlet surgery versus medical management.

Main Methods:

• Retrospective cohort study using the TriNetX Research Network.
• Propensity score-matched (PSM) analyses comparing endoscopic outlet surgery (TURP, GreenLight PVP, laser enucleation, Aquablation) to alpha-blocker monotherapy or combination therapy.
• 10,048 matched pairs were included after exclusion and matching on demographics, comorbidities, and healthcare utilization.

Main Results:

• Endoscopic outlet surgery was associated with significantly lower rates of depression and anxiety at 1, 3, and 5 years compared to alpha-blocker monotherapy.
• Surgery demonstrated greater protective effects for depression and anxiety compared to combination therapy over 5 years.
• No significant differences were observed for suicidal ideation or bipolar disorder between surgical and medical management.

Conclusions:

• Endoscopic outlet surgery is linked to a reduced risk of developing depression and anxiety.
• These mental health benefits were observed over a five-year follow-up period.
• Surgical intervention for BPH may offer advantages beyond lower urinary tract symptom relief.