Comparative Effectiveness of Transurethral Prostate Procedures at Enabling Urologic Medication Discontinuation: a Retrospective Analysis.

To test the hypothesis that transurethral prostate procedures (TUPPs) eliminating tissue result in greater medication discontinuation and lower de-novo initiation rates than procedures inducing tissue necrosis.Retrospective review of all men undergoing first time TUPPs at a large tertiary center from 2001-2016 was completed. Procedure type and urologic medication use before, 3-12 months after, and greater than 12 months after TUPP were analyzed with simple open prostatectomy (SP) as a comparator. Tissue-eliminating TUPPs included transurethral resection (TURP) and laser prostatectomy (LP). Tissue-necrosing procedures included microwave therapy (TUMT) and radiofrequency ablation (TUNA), which were grouped in analyses. Medication types were 5-alpha reductase inhibitors (5ARI), alpha-blockers (AB), anticholinergics (AC), and beta-3 agonists (B3A).A total 5,150 TUPPs were analyzed. Preoperative medication use significantly varied across TUPPs for 5ARI (p < 0.01), AB (p 0.01), and AC (p 0.047), but not B3A (p 0.476). TURP and LP were associated with significantly higher medication discontinuation rates and lower resumption and initiation rates compared to tissue-necrosing procedures. Relative to TUPPs, SP had significantly higher medication discontinuation, as well as the lowest resumption and initiation rates.Tissue-eliminating BPH procedures were associated with better medication discontinuation, resumption, and de-novo initiation rates compared to tissue-necrosing BPH procedures.