The expectation for many men who undergo surgery to treat lower urinary tract symptoms from benign prostatic obstruction is that they will experience complete resolution of their symptoms. However, the reality may be different.
In fact, half or more of men who underwent surgery in a retrospective study remained on medication to treat their symptoms between six months and two years later. Researchers at the University of Miami Miller School of Medicine said that result was unexpected.
“We were very surprised to find such a high rate of postoperative medication use,” said Jesse Ory, M.D., lead author of the study published in World Journal of Urology.
“Surgery, in theory, is supposed to be definitive for men with LUTS, and one of the goals – in addition to improving symptoms – should be to stop medications, which can have long-term adverse effects,” added Dr. Ory, who was affiliated with the Department of Urology at the Miller School at the time of the study.
Dr. Ory, senior author Ranjith Ramasamy, M.D., and their colleagues are the first researchers to evaluate postoperative medication use in this patient population across a number of different surgical approaches.
Surgery Treatments Vary
They compared 21,475 men treated with medication for LUTS who later underwent one of six interventions. These patients were treated with either transurethral resection of the prostate, Laser vaporization of prostate, transurethral incision of the prostate, prostatic urethral lift, water-vapor thermal therapy, or Laser enucleation of the prostate.
Dr. Ory said there is a new awareness of medication discontinuation within urology to measure surgical success, adding that LEP was the only strategy where fewer than half, 38%, of men had stopped their medication postoperatively.
“We found that, in spite of surgery, patients continue getting medication refills up to two years later,” said study co-author Hemendra Shah, M.D., a urologist at UHealth who specializes in endourology and stone diseases.
The rates of postoperative medication continuation were 66% for PVP, 65% for TUIP, 63% for PUL, 61% for TURP and 50% for WV.
“LEPs have the lowest chance of needing medical management – which is where we can use our findings to counsel patients,” Dr. Shah said.
Dr. Ory and colleagues also compared the surgeries based on a more traditional outcome – the percentage of re-operations. Again, LEP had the most favorable outcome.
The researchers also addressed the disparity between the high rates of postoperative medication use and relatively low rates of surgical retreatment.
“This reinforces the message that men who have persistent LUTS following surgery should be investigated further by means of cystoscopy or urodynamics prior to restarting medical therapy,” Dr. Ory said.
Database Provides Insight
Access to the TriNetX Analytics Network database allowed the researchers to study a large number of men who underwent BPO surgery for LUTS.
Dr. Ory also credits his co-authors for the success of the study.
“Dr. Ramasamy is an invaluable mentor who helped me navigate the inner workings of the large TriNetX database to answer this question,” Dr. Ory said. “Dr. Hemendra Shah was instrumental in understanding the nuances of BPO treatment.”
The most common class of BPO medication used by men prior to surgery, in order, were alpha blockers, followed by 5-alpha-reductase inhibitors, and antispasmodic medications.
“The medications we typically use were thought to be relatively benign, but some new research has shown that long-term use may have adverse consequences,” Dr. Ory said. “Hopefully this motivates researchers to include medication discontinuation as an outcome in future trials.”
Some questions remain. For example, are men staying on medications postoperatively because they still have symptoms despite surgery? Or is it because they have received inadequate counseling to stop the drugs? Dr. Ory said the research continues.
“Because we don't know this, we hope that the information from our study will motivate physicians to ask about LUTS medications during follow-up visits.”