Initiation of Medical Therapy for Storage Lower Urinary Tract Symptoms After Benign Prostatic Hyperplasia Surgery

PURPOSE: De-novo anticholinergic or beta-3 agonist (Ach/B3a) initiation for storage lower urinary tract symptoms (LUTS) is a clinically significant but understudied outcome after benign prostatic hyperplasia (BPH) surgery. We estimated procedure-specific cumulative incidence of Ach/B3a medication initiation and identified associated patient- and procedure-level factors. MATERIALS AND METHODS: Using Michigan statewide claims data (2017-2022) from the Michigan Value Collaborative, Ach/B3a-naive patients who underwent BPH surgery were identified. Procedures included transurethral resection of the prostate (TURP), laser photovaporization (PVP), laser enucleation of the prostate (LEP), robotic waterjet therapy (RWJT), prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), transurethral microwave thermotherapy (TUMT), prostatic artery embolization (PAE), and simple prostatectomy (SP). De-novo Ach/B3a initiation was defined as a prescription fill for an Ach/B3a between 3 and 12 months postoperatively. Cumulative incidence was estimated by Kaplan-Meier analysis; Cox proportional hazards models identified associated factors. RESULTS: The cohort comprised 11,519 Ach/B3a medication-naive patients. Twelve-month cumulative incidence ranged from 5.7% (TUMT) to 11% (PVP). On multivariable analysis, PVP was associated with higher hazard of initiation compared to TURP (HR 1.49, 95% CI 1.25-1.79). Prior BPH medication use, and prior anticoagulation use were associated with higher hazard of initiation, while preoperative catheter dependence was associated with lower hazard. CONCLUSIONS: In this statewide cohort of Anticholinergic and Beta-3 agonist naive patients undergoing contemporary BPH procedures, de-novo Ach/B3a medication initiation was uncommon but procedure-specific, with 12-month cumulative incidence ranging from 5.7% - 11%, with PVP carrying the highest hazard. These findings provide real-world benchmarks to guide counseling across contemporary BPH interventions.