Disclosure
Romuald Zdrojowy received a consultation fee for the manuscript editing. Aleksander Jerzy Owczarek received honorarium for statistical analysis. Magdalena Olszanecka-Glinianowicz received honorarium for the project drafting. Agnieszka Almgren-Rachtan is employed by Europharma Rachtan Co. Ltd (Director of the Department of Pharmacovigilance). Jerzy Chudek received honorarium for data analysis and manuscript drafting.
Address for correspondence:
Jerzy Chudek MD
Department of Internal Medicine and Oncological Chemotherapy
ul. Reymonta 8
40-029 Katowice
Poland
chj@poczta.fm
Pharmacotherapy of patients with benign prostate enlargement and storage symptoms in daily clinical practice
Abstract
Purpose: Storage symptoms significantly deteriorate the quality of life in men with benign prostate enlargement (BPE). Muscarinic receptor antagonists (MRAs) and β3-adrenergic receptors agonists alone, or in combination with selective α1-alpha-antagonists (ARAs), are considered as the most effective medicines relieving storage symptoms.
The aim of this study was to analyze pharmacotherapy of storage symptoms in men with BPE, and their compliance with the European Association of Urology (EAU) guidelines.
Patients and methods: The survey was conducted in 2018 by 261 urologists among 37,165 outpatients with lower urinary tract symptoms (LUTS) treated pharmacologically, including 24,613 men with BPE (age 69 ± 8 years). Data concerning recent severity of non-neurological LUTS and storage symptoms (urinary urgency, frequency and nocturia) and pharmacotherapy were collected.
Results: Storage symptoms were reported by 12,356 patients (50.2%) with BPE, more frequently nocturia (75.8%), than urinary urgency (57.8%) and urinary frequency (44.3%). Patients with storage symptoms were more frequently prescribed with MRAs and mirabegron (43.1% vs. 5.0%; p < 0.001; and 2.4% vs 0.3%; p < 0.001; respectively). Of note, 54.5% of patients with storage symptoms were treated neither with MRAs nor β3-adrenergic receptors agonists. In the subgroup with storage symptoms, the increasing severity of LUTS accounted for more frequent prescription of MRA based pharmacotherapy (2.1% vs 29.1% vs 42.8% in patients with mild, moderate, and severe LUTS, respectively).
Decision tree analysis revealed that patients with urinary urgency and urinary frequency as well as younger ones with urinary urgency but without urinary frequency were more frequently prescribed with MRAs.
Conclusion: Urinary urgency and frequency are associated with increased utilization of MRAs in men with BPE in daily clinical practice. The attitude of Polish urologists toward management of persistent storage symptoms in BPE patients is in line with the EAU guidelines.
Kew words: non-neurogenic Lower Urinary Tract Symptoms, pharmacotherapy, real-life data, muscarinic receptor antagonists, urinary urgency, urinary incontinence
WHAT’S KNOWN?
Till now the only knowledge concerning the daily prescribing practice of Polish urologists in men with lower urinary tract symptoms (LUTS) is coming from a survey performed, shortly after the publication of the 2013 edition of the European Association of Urology (EAU) guidelines. This survey assessed the urologists declarations concerning therapy, but did not verify their daily prescribing practice.
WHAT’S NEW?
We present for the first time real-life data concerning current pharmacotherapy for benign prostate enlargement (BPE) and the effect of storage symptoms on the utilization of urological drugs, including muscarinic receptor antagonists in Poland. We showed the attitude of Polish urologists toward management of persistent storage symptoms in BPE patients in line with the EAU guidelines. Currently, muscarinic receptor antagonists are more frequent used in triple, than double schedule, probably due to relatively high costs of these drugs.