Medication Use After Surgery for Benign Prostatic Hyperplasia Is the Norm Rather than the Exception

Real-world data from a large clinical database showed that many patients continue to use medications to relieve lower urinary tract symptoms (LUTS) after undergoing surgical procedures for benign prostatic hyperplasia (BPH). A series of studies presented at the 2026 Annual Meeting of the American Urological Association in Washington, D.C. showed that a large proportion of patients were using monotherapy or combination medical therapy for BPH within 2 years after surgery. 

Men with BPH often experience lower urinary tract symptoms, which have a negative impact on their quality of life. The expanding armamentarium for the treatment of BPH now includes various minimally invasive procedures designed to provide long-lasting relief when lifestyle changes and pharmacotherapy fall short. Nevertheless, in many cases, LUTS may not resolve completely after surgery or may recur after an initial period of relief. 

In a retrospective analysis conducted at the University of Vermont Larner College of Medicine, the researchers used data collected from more than 40,000 men worldwide over two decades to compare medication discontinuation rates after common surgical interventions for BPH. The analysis showed that less than one-quarter of all patients remained medication-free 2 years after undergoing surgery. Nearly 80% of the participants continued to receive prescriptions for at least one medication for LUTS, with alpha-blocker monotherapy ranking as the most common treatment. Other options included 5-alpha reductase inhibitors (5-ARIs), phosphodiesterase type-5 inhibitors, antimuscarinics, and beta-3 agonists. 

The study also showed that the likelihood of discontinuing medical therapy after surgery varied depending on the type of procedure. Holmium laser enucleation of the prostate (HoLEP), photoselective vaporization of the prostate (PVP), and prostatic urethral lift (UroLift) were associated with significantly higher odds of discontinuing medications compared with transurethral resection of the prostate (TURP), whereas patients undergoing robotic waterjet therapy (RWT) were more likely to continue medical therapy. 

A second retrospective analysis that included data collected from more than 50,000 patients between 2006 and September 2025 revealed that a large majority of men resumed medical therapy for LUTS even earlier in the postoperative period, with 77.5% of patients receiving prescriptions for at least one BPH-related medication by 1 year following their index surgery. Monotherapy was most commonly prescribed in this cohort (74.7%), whereas combination therapy accounted for one-quarter of the postoperative medical regimens. Alpha blocker use was predominant among those receiving monotherapy (36.2%). Both analyses showed that the most common combination therapy consisted of alpha blockers paired with 5-ARIs. 

“Our study suggests that, for most men, BPH surgery does not present an offramp for medical therapy in men with LUTS, with a majority of patients being on one or more medications at 1 year post-outlet procedure,” the authors concluded. “These findings can assist medical providers in counseling patients on realistic expectations regarding postoperative medication use after surgical management of BPH.” 

The authors noted that medical records may paint an incomplete picture of the LUTS that men experience after undergoing surgical procedures for BPH, which should become a focal point in the patient-clinician discussion in the postoperative period. Moreover, the rates of adherence to prescribed medications may be difficult to determine based on information obtained from electronic health records. By understanding the patterns of medication use after surgery, providers may be better equipped to counsel patients on treatment options for BPH and address the unmet needs of patients living with LUTS.