Endoscopic Outlet Surgery vs Medical Therapy for Benign Prostatic Hyperplasia: Impact on Incident Mood Disorders.
Endoscopic surgery for benign prostatic hyperplasia linked to lower 5-year depression risk than alpha-blockers.
Endoscopic Outlet Surgery vs Medical Therapy for Benign Prostatic Hyperplasia: Impact on Incident Mood Disorders.
To compare the incidence of new-onset depression, anxiety, suicidal ideation, and bipolar disorder among men with BPH treated with endoscopic outlet surgery vs medical management.
Using the TriNetX Research Network, we conducted a retrospective cohort study with 2 parallel 1:1 propensity score-matched (propensity score-matched) analyses comparing endoscopic outlet surgery (TURP, GreenLight PVP, laser enucleation of the prostate, or Aquablation) to (1) third-generation alpha-blocker monotherapy and (2) combination alpha-blocker/5α-reductase inhibitor therapy.
5 years out, surgery patients had lower depression risk than alpha-blocker users
Compared to combination therapy, surgery demonstrated greater protective effects for depression (5-year RR 0.70, 95% CI 0.62-0.79) and anxiety (5-year RR 0.77, 95% CI 0.69-0.86).
No differences were observed for suicidal ideation or bipolar disorder.
In sensitivity analyses restricted to those with ≥3 prescriptions of tamsulosin monotherapy or ≥3 prescriptions each of tamsulosin and finasteride, the protective effects of surgery were further strengthened for both depression and anxiety across all time points (all P <.0001).
Endoscopic outlet surgery is associated with significantly lower risk of incident depression and anxiety compared to both medical management strategies over 5 years of follow-up.