Medication Discontinuation Following Transurethral Prostatectomy: an Unrecognized Effectiveness Measure?
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BENIGN PROSTATIC HYPERPLASIA (K MCVARY, SECTION EDITOR)
Medication Discontinuation Following Transurethral Prostatectomy: an Unrecognized Effectiveness Measure? Rebecca A. Campbell 1 & Bradley C. Gill 1,2,3 Accepted: 15 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Freedom from medication is a common goal for patients undergoing surgical treatment of benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS). Knowing medication discontinuation rates following various forms of transurethral prostatectomy may aid patient counseling and assessing the comparative effectiveness of different approaches. This review examined discontinuation rates of BPH/LUTS medications following transurethral prostatectomy. Recent Findings Rates of BPH/LUTS medication use after transurethral resection of the prostate varied from 15% to 55%, and discontinuation rates were 54–95% across medications and follow-up periods. For laser prostatectomy, approximately 18% of patients continued medications postoperatively and discontinuation rates ranged from 53% to 75%. Minimal data on holmium laser enucleation existed. For reference, medication discontinuation rates after transurethral needle ablation or microwave therapy were only 15–28%. Summary No recommendations or best practices inform the use of medical therapy following BPH surgery. Rates of BPH/LUTS medication use following transurethral prostatectomy are considerable. Keywords Benign prostatic hyperplasia . Prostate . Lower urinary tract symptoms . Medication . Alpha blocker . 5-Alpha reductase inhibitor
Introduction As the incidence of benign prostatic hyperplasia (BPH) increases over time with the shift toward an aging population, new surgical therapies have been introduced [1]. Transurethral resection of the prostate (TURP) was long considered the “gold standard” for BPH treatment [2]. However, the AUA guidelines, now stratified by prostate size, list other therapies as size-specific options, including: photoselective This article is part of the Topical Collection on Benign Prostatic Hyperplasia * Bradley C. Gill [email protected] 1
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Mail Stop Q10-1, 9500 Euclid Ave, Cleveland, OH 44195, USA
2
Department of Urology, Cleveland Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH, USA
3
Section of Urology, Surgical Service, Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
vaporization of the prostate (PVP) or laser prostatectomy (LP), water vapor thermal therapy, the prostatic urethral lift, holmium laser enucleation of the prostate (HoLEP), and simple prostatectomy [3]. Comparison of these modalities is a must, to determine not only which are most effective but also which are best suited for a particular patient. Current measures of effectiveness include the American Urological Association Symptom Score/ International Prostate Symptom Score (AUA SS/IPSS), Quality of Life (QOL) questions,
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