To evaluate the impact of Minimally Invasive Surgical Therapies (MISTs) on surgical trends for Lower Urinary Tract Symptoms (LUTS) caused by Benign Prostatic Obstruction (BPO) in Australia.

Population-adjusted rates of BPO related surgeries in Australia (January 2004 – September 2024) were analysed using publically available Medicare Statistics and Census Data focusing on MBS item numbers: 36811, 37200, 37201, 37203, 37204, 37205, 37207, 37230, and 37245. Independent t-tests and significance levels compared rates before and after the introduction of Prostatic Urethral Lift (PUL) and Rezum on 1st March 2024.

From January 2004 to September 2024, 301,648 BPO-related procedures were claimed under the MBS in Australia, with Transurethral Resection of the Prostate (TURP) compromising 78% (n=235,422). PVP accounted for 11%, enucleation 4%, PUL 4%, TUNA 1%, simple prostatectomy 1%, and TUMT < 1%. Annual BPO surgery incidence rose from 112.5 to 130.2 per 100,000 adult men (2004-2023). TURP incidence peaked in 2009 but declined with increased uptake of enucleation and PVP. Post-introduction of UroLift and Rezum, most procedural rates increased, except TUNA and PUL, which declined significantly (p=0.0008; p < 0.001, respectively). TURP and PVP rates remained stable (p=0.06; p=0.14, respectively), while enucleation (p=0.008) and simple prostatectomy (p=0.027) increased. Procedures were most common in men aged 65-74, with rising rates in those aged > 85 years. CONCLUSION

BPO surgical trends in Australia have shifted over the past two decades, with TURP declining as MISTs, PVP and enucleation uptake increased. Advances in MISTs are expected to shape the future of BPO surgeries thereby expanding the BPO surgical marketplace.