Benign prostatic hyperplasia (BPH) is a ubiquitous condition. Although most patients with BPH are managed conservatively or with medical treatment, an estimated 2% to 5% undergo surgical intervention. Often, surgical intervention is associated with more advanced disease, with a pronounced impact on patient quality of life. For surgical management, a multitude of ever-expanding treatment options exist—each associated with varying effectiveness, durability, and complication profiles. These interventions also differ in the cost, resources, equipment, and training required to implement. However, limited data exist to elucidate the impact of patient and provider factors on BPH surgical access and utilization. Specifically, we know that access to care is a critical issue for all aspects of medical care, including urologic surgery. Prior data have shown notable disparities by race in overall access to BPH surgery and the specific types of BPH surgery performed.¹ Furthermore, comparisons of treatment success, indeed even definitions and quantification of treatment success, are severely limited within the literature.

It is in this background that the AUA Quality (AQUA) Registry offers clear advantages. With inclusion of over 200 practices and 10 million patients, it represents a large dataset that also offers uniquely granular data. We plan to utilize the BPH cohort to perform the first large-scale analysis of patient access, utilization, and outcomes related to BPH surgical interventions. Additionally, the AQUA Registry is more representative of the US BPH practice—with a large proportion of providers practicing in a private setting. We believe that such analyses will have a clear and significant impact. First, information on access to care will help identify groups of patients and providers with limited access to specific treatment options. Second, comparative outcomes data can be used to guide patient and provider decisions on the best surgical intervention. This has potential implications on a patient decision-aid level as well as to inform BPH surgical guidelines. Third, these data can further define clinical phenotypes of BPH to identify patients needing specific interventions more accurately—a high priority area identified in the most recent BPH surgical guidelines from the AUA.

By obtaining high-volume, disease-specific outcomes, this project marks a unique opportunity and serves as a natural progression of our team’s previous and ongoing work evaluating BPH cost-effectiveness and patient-reported outcomes. Data from this project will help provide more robust clinical outcomes metrics, better define patients in need of specific interventions, and identify groups of patients and providers that may be under-resourced. The data and analyses will serve as a key adjunct for our team’s broader goal of a comprehensive assessment of surgical treatment options for BPH. Ultimately, these combined data can better inform patient and provider decisions on an individual level as well as guide policy-level decisions in the future.

Editor’s Note: The team of principal investigator Kevin Michael Wymer, MD, and co-investigators Mitchell Humphreys, MD, Kevin Koo, MD, MPH, MPhil, and Aaron Potretzke, MD, was one of 6 research groups awarded a 2024 AUA Data Research Program Grant. Awardees use clinical data from the AUA Quality (AQUA) Registry or AUA Annual Census data to conduct clinical and workforce studies. Applications for the 2025 AUA Data Research Program will open in May.