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.