Rates and Predictors of Persistent LUTS Medication Use After Laser Enucleation of the Prostate

Abstract

Objectives: To assess rates of medication use for lower urinary tract symptoms (LUTS) over time following laser enucleation of the prostate (LEP) and to identify preoperative predictors of persistent use. Methods: We retrospectively analyzed 864 LEP patients from an institutional tertiary-care database (11/2017–05/2023) with available 24-month follow-up on medication use. Patient-reported use of five drug classes (alpha-blockers, 5-alpha-reductase (AR)-inhibitors, anticholinergics, beta-3-agonists, and phosphodiesterase (PDE)-5-inhibitors) was recorded preoperatively and at one, three, 12, and 24 months after the procedure. Univariable and multivariable logistic regression models were fitted to identify predictors of persistent LUTS medication use. Results: Preoperatively, 84.9% of patients used LUTS medication, decreasing to 12.6% within 24 months of follow-up. Alphablocker (80.9%) and 5-AR-inhibitor (13.8%) use declined to 1.8% and 0%, respectively. Anticholinergic (4.6%) and beta-3-agonist (0.3%) use showed a transient postoperative increase with peaks of 10.9% and 1.0% at 3 months, followed by a decline to 2.7% and 0.4% at 24 months, respectively. PDE-5-inhibitor use (1.8%) increased steadily to 5.4% at 24 months. Patient with persistent use exhibited worse baseline QoL and ICIQ-SF scores and higher rates of adiposity, diabetes mellitus, and ASA score III/IV. In multivariable analysis, only preoperative PDE-5-inhibitor use (adjusted OR 3.26, p = 0.002) and ASA score III/IV (adjusted OR 2.08, p = 0.016) remained independently associated with persistent LUTS medication use. Conclusion: LUTS medication use decreased substantially after LEP, with only a small subset requiring continued medication at 24 months. Preoperative PDE-5-inhibitor use and higher comorbidity burden emerged as independent predictors of persistent LUTS medication use. These findings can refine preoperative counseling regarding postoperative LUTS medication dependence.