Treatment of benign prostatic hyperplasia and occurrence of prostatic surgery and acute urinary retention: a population-based cohort study in the Netherlands.
OBJECTIVE
To assess and compare the risk of prostatic surgery in (subsets of) patients with a diagnosis of BPH. We sought to expand on data of an earlier pharmacy-based study by obtaining more information on BPH disease parameters by using a Dutch GP-based research database.


METHODS
A retrospective cohort study (1994-mid-year 2002) was conducted among 1430 men aged > or =45 years with > or =6 months of registration with the GP. BPH case identification was based on review of medical records.


RESULTS
Overall, we found that there was no difference in the risk of prostatic surgery between patients on medical treatment and watchful waiting. Patients using 5alpha-reductase inhibitors (5-ARIs) at any stage had a statistically significant reduced risk of surgery compared to patients using alpha-blockers only: adjusted hazard ratio 0.35 (95%CI: 0.13-0.96). The routine collection of BPH parameters were insufficient to be useful in the analysis.


CONCLUSIONS
Patients using 5-ARIs seemed to have a reduced risk of prostatic surgery compared to patients using alpha-blockers. However, it was unknown whether the disease profile of 5-ARI users is different compare to non-5-ARI-treated and untreated patients with BPH, as detailed medical information necessary to characterise patients according to the BPH disease severity and development of disease parameters is not routinely recorded by GPs.
Souverein
P C
PC
Department Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO BOX 80082, 3508 TB Utrecht, The Netherlands. P.C.Souverein@pharm.uu.nl
van Riemsdijk
M M
MM
de la Rosette
J J M C H
JJ
Opdam
P C E
PC
Leufkens
H G M
HG
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D042944:Cholestenone 5 alpha-Reductase / Q000037:antagonists & inhibitors; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D011470:Prostatic Hyperplasia / Q000601:surgery* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016055:Urinary Retention / Q000453:epidemiology* / Q000209:etiology
D042944:Cholestenone 5 alpha-Reductase