EPV969
Beyond Symptom Control: Surgical Treatment of Benign Prostatic Hyperplasia and Reduced Risks of Depression, Anxiety, and Dementia
S.-K. Kao 1,*, W.-Y. Cheng 2, Y.-T. Yu 3, W.-H. Tseng 2 4
1Psychiatry, Taipei Veterans General Hospital, Taipei, 2Urology, Chi Mei Medical Center, Tainan, 3Community Medicine, Landseed International Hospital, Taoyuan, 4Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
Introduction: Benign prostatic hyperplasia (BPH) is a common urological condition in aging men, often causing lower urinary tract symptoms (LUTS). LUTS are linked not only to impaired quality of life but also to psychiatric disorders, sleep disturbances, and cognitive decline. While surgical treatment is widely used to relieve bladder outlet obstruction, its long-term impact on psychiatric and cognitive outcomes remains unclear.
Objectives: To evaluate whether surgical treatment for BPH is associated with reduced risks of psychiatric disorders, sleep disturbances, cognitive decline, and persistent LUTS.
Methods: A retrospective cohort study was conducted using the TriNetX Global Collaborative Network (155 healthcare organizations). Male patients aged ≥18 years with BPH (2015–2024) were included. Patients with baseline psychiatric disorders were excluded. The study population was divided into surgical (n = 20,328) and non-surgical (n = 1,659,904) cohorts. After 1:1 propensity score matching, 20,323 patients remained in each group. Outcomes within three years included depression, anxiety, insomnia, dementia, delirium, and LUTS. Hazard ratios (HR) and p-values were calculated. Subgroup analyses were performed by age and BPH medication use.
Results: Surgical patients had lower risks of persistent LUTS (HR 0.917, p < 0.001), depression (HR 0.616, p < 0.001), anxiety (HR 0.551, p < 0.001), insomnia (HR 0.645, p < 0.001), dementia (HR 0.705, p = 0.013), and delirium (HR 0.694, p = 0.007). Benefits were more pronounced in men aged 18–70 for LUTS, depression, anxiety, and insomnia, whereas men >70 mainly benefited for depression, anxiety, and dementia. Protective effects were stronger in patients not taking medications.
Table 1. Risk of Psychiatric Disorders and LUTS in BPH Patients Undergoing Surgery versus Non-Surgical Controls (BPH = Benign Prostatic Hyperplasia; LUTS = Lower Urinary Tract Symptoms; HR = Hazard Ratio; CI = Confidence Interval; * p < 0.05; *** p < 0.001)
Outcome |
Surgery (N= 20,323) |
non-Surgery (N= 20,323) |
Hazard ratio (95% CI) |
p value |
|
LUTS |
3004 |
3706 |
0.917 (0.874, 0.963) |
< 0.001*** |
|
Depression |
106 |
196 |
0.616 (0.486, 0.780) |
< 0.001*** |
|
Anxiety |
144 |
297 |
0.551 (0.451, 0.672) |
< 0.001*** |
|
Insomnia |
90 |
159 |
0.645 (0.498, 0.835) |
< 0.001*** |
|
Dementia |
81 |
131 |
0.705 (0.535, 0.930) |
0.013* |
|
Delirium |
86 |
141 |
0.694 (0.530, 0.907) |
0.007* |
Image 1. Kaplan–Meier Curve of Psychiatric Disorder Risk in BPH Patients Undergoing Surgery versus Non-Surgical Controls (BPH = Benign Prostatic Hyperplasia)
Image 2 & 3. Subgroup Analysis Forest Plot of Outcomes After Surgery versus Controls (BPH = Benign Prostatic Hyperplasia; LUTS = Lower Urinary Tract Symptoms; HR = Hazard Ratio; CI = Confidence Interval)
Image 1:
Image 2:
Image 3:
Conclusions: Surgical treatment for BPH is associated with reduced risks of psychiatric disorders. Beyond relieving urinary obstruction, surgery may confer broader mental health and cognitive benefits.
Disclosure of Interest: None Declared