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The Impact of BPH Care: Procedural complications associated with MIST and traditional surgery compared to disease progression with medical therapy

Introduction & Objectives

Surgical intervention delivers treatment in one setting while medical therapy is affected by lack of compliance and discontinuation. A comprehensive analysis of real-world data was performed in an attempt to compare complications and procedures subsequent to a surgical intervention for LUTS / BPH vs. the use of daily medication.

Materials & Methods

Patient-level data on men with a BPH diagnosis who received medical therapy only (α-blockers, 5-ARIs, anti-cholinergics, β3-agonists, PDE5-inhibitors); MIST (UroLift PUL, Rezum WVTT) or invasive surgery (TURP, PVP, Aquablation) in an outpatient setting from 2015-2021 were analyzed in a representative sample of US Medicare and commercial claims (IBM Watson). Procedures (either post-operative following surgery or occurring after initiation of medical therapy) were identified with CPT codes. For medical therapy patients, ICD diagnosis codes were used to elucidate underlying causes. Overall event rates through 12 months post-treatment were calculated via cumulative incidence curves.


203,504 medical therapy patients we analyzed and on treatment for a mean 716 days; the most common being Tamsulosin (n=75,698) and Tadalafil (n=55,129). 5.5% of medication patients underwent procedures, cystoscopy (n=9,920), catheterization (n=1,792), and bladder irrigation (n=975) being most frequent. Mean time to onset for any event was 121 days. Diagnoses that drove cystoscopies included LUTS symptoms and urinary retention. For the surgical cohort, 24,035 TURP, 11,911 PVP, 84 Aquablation, 8,649 PUL, and 1,944 Rezum comprised the population. Procedural complication rates were lowest after PUL (17%), highest for Rezum (28%), and comparable among the invasive surgeries: 20%, 21%, 22% for Aquablation, TURP, and PVP, respectively. Top complications for MIST and traditional surgeries were cystoscopies, catheterizations, and bladder irrigations.


Limitations notwithstanding, we reveal ~6% of medical therapy patients undergo procedures through 1 year as disease progresses.  Procedure complication rates were similar between TURP and PVP yet lowest for PUL. Although the Aquablation data are relatively immature due to the newness of the technology, the 20% rate reflects a safety profile similar to TURP and higher than PUL.