title: Use of Medical Therapy and Success of Laser Surgery and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia.
abstract: OBJECTIVE
  To assess the impact of surgery for benign prostatic hyperplasia (BPH) on use of medication (5-alpha reductase inhibitors, alpha blockers, antispasmodics), we assessed preoperative and postoperative medication utilization among surgically treated men.
  
  
  METHODS
  Using the Truven Health Analytics MarketScan Commercial Claims Database, we defined a cohort of men aged <65 years who had surgical therapy for BPH with either transurethral resection of the prostate (TURP) or laser procedures from 2007 through 2009. Primary outcomes included freedom from medical or surgical intervention by 4 months after surgery (chi-square and multivariable logistic regression) and subsequent use of medical or surgical intervention in initial responders (Kaplan-Meier and multivariable Cox regression).
  
  
  RESULTS
  We identified 6430 patients treated with either TURP (3096) or laser procedure (3334) for BPH. Presurgical antispasmodic use was associated with the highest risk of medication use at 4 months after surgery (odds ratio, 5.19; 95% confidence interval (CI), 3.16-8.53 vs no medication use before surgery). At 3 years after surgery, 6% (95% CI, 4%-8%) of laser-treated and 4% (95% CI, 2%-5%) of TURP-treated patients had repeat surgical intervention, and both laser- and TURP-treated patients had an estimated new use of medication rate of 22% (95% CI, 18%-25% laser and 20%-25% TURP). The strongest predictor of intervention after surgery was preoperative antispasmodic use (hazard ratio, 2.49; 95% CI, 1.41-4.43).
  
  
  CONCLUSIONS
  Our results show a need for effective patient counseling about continued or new use of medical therapy after laser and TURP procedures. However, most patients experience durable improvement after surgical intervention for BPH.
authors.affiliation: Division of Urology, Department of Surgery, Washington University, St. Louis, MO. Electronic address: stropes@wudosis.wustl.edu.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Strope
authors.affiliation: Division of Urology, Department of Surgery, Washington University, St. Louis, MO.
authors.forename: Joel
authors.initials: J
authors.lastname: Vetter
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, MN.
authors.forename: Sean
authors.initials: S
authors.lastname: Elliott
authors.affiliation: Division of Urology, Department of Surgery, Washington University, St. Louis, MO.
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Andriole
authors.affiliation: Department of Internal Medicine, Washington University, St. Louis, MO.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000328:Adult; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D006801:Humans; D053685:Laser Therapy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010276:Parasympatholytics / Q000627:therapeutic use*; D011184:Postoperative Period; D057234:Preoperative Period; D011470:Prostatic Hyperplasia / Q000150:complications / Q000628:therapy*; D053448:Prostatism / Q000209:etiology / Q000628:therapy*; D012086:Reoperation; D020728:Transurethral Resection of Prostate / Q000706:statistics & numerical data*
chemical_list: D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists; D010276:Parasympatholytics