Presentation Authors: Jeffrey Campbell*, London, Canada, Jennifer Reid, Michael Ordon, Toronto, Canada, Blayne Welk, London, Canada
Introduction: There is little evidence to support the use of prostate- or bladder-specific medications after surgical intervention for benign prostatic hyperplasia (BPH). Our objective is to determine the frequency of medical management of urinary symptoms after transurethral resection of the prostate (TURP).
Methods: Several linked, routinely collected datasets from the province of Ontario, Canada were used for this population-based study. We identified all men older than 65 years of age who underwent their first TURP between April 2003 and March 2016. Men with prior prostate cancer, and those who had a simultaneous bladder tumor resection were excluded. The primary outcome was the probability of using at least 30 days of either an alpha blocker (AB), 5-alpha reductase inhibitor (5ARI), or an anticholinergic/beta-3 agonist (AC/B3). Men were observed for utilization of these medications from 90 days after TURP until censoring or March 2017.
Results: We identified 58,038 men with a median age of 75 years and a median follow-up of 4.9 years. In the 6 months prior to their TURP, AB, 5ARIs or AC/B3 were used by 62%, 32%, and 6% respectively. Following a 90-day washout period after TURP, these medications were used by 30%, 22%, and 17% of men respectively. The cumulative probability of using these medications within the first 5 years after TURP was 0.28, 0.21, and 0.17 respectively. Primary care physicians prescribed the majority of AB, while urologists prescribed the majority of the AC/B3. The median time to first use was approximately 1 year, and the median duration of use was >1 year for both AB and 5ARIs. Among men on AC/B3 prior to TURP, 46% used them after TURP; in multivariate cox regression analysis age greater than 75, diabetes, preoperative use of AC/B3, and no preoperative urinary retention predicted postoperative utilization of AC/B3 medications.
Conclusions: Prescription of AB and 5ARIs is quite high after TURP, despite minimal physiological basis (AB) or lack of evidence (5ARIs) for using these medications. Given the lack of clinical indication and the well-characterized placebo response in BPH patients, this practice should be properly evaluated for clinical efficacy.
Source of Funding: St. Joseph's Health Care London, Foundation