title: Management of lower urinary tract symptoms related to benign prostatic hyperplasia in real-life practice in france: a comprehensive population study.
abstract: BACKGROUND
  Male lower urinary tract symptoms (LUTS) are one of the most treated diseases, but little is known about patient trajectories in current clinical practice.
  
  
  OBJECTIVE
  To describe the dynamic treatment patterns of LUTS presumably due to benign prostatic obstruction (BPO).
  
  
  METHODS
  All prescriptions of α1-adrenergic receptor blocking agents (α1-blockers), 5α-reductase inhibitors (5-ARIs), and phytotherapy, and all surgeries related to BPO performed in France from 2004 to 2008 were identified using two distinct administrative claim databases maintained by the National Health Insurance system that covers the entire population. After linking the two data sets, all consecutive treatment events were analyzed for each patient.
  
  
  METHODS
  Drug prescription details were assessed for each year, region, and prescriber qualification. Medical treatment initiation, interruption, evolution, and events after surgical management (hospital stay, reoperation, complication rates, and subsequent medical prescriptions) were also investigated.
  
  
  CONCLUSIONS
  Overall, 2 620 269 patients were treated within 5 yr, with important geographic variations. Medical treatment was interrupted for approximately 16% of patients. The α1-blockers were prescribed most frequently, but phytotherapy surprisingly accounted for 27% of all monotherapies and 54% of all combination therapies. General practitioners and urologists (92% and 3.7% of overall prescribers, respectively) exhibited a similar prescription profile. Treatment initiation was medical in 95.4% of cases, consisting primarily of monotherapy using α1-blockers (60.3%), phytotherapy (31.8%), or 5-ARIs (7.9%). Treatment was modified at extremely high rates within 12 mo of initiation (8.7%, 14.6%, and 12.9%, respectively). The median hospital stay for surgical management was far higher than in clinical trials. Long-term surgical complications and reoperation rates favored open prostatectomy. Incidence of pharmacologic treatment after surgery was as high as 13.8% at 12 mo.
  
  
  CONCLUSIONS
  This unique dynamic evaluation of clinical practice revealed unexpected results that contrast with previously published evidence from clinical trials. This approach may merit monitored and targeted measures to improve the level of care in the field.
authors: Department of Urology, Tenon Hospital, Assistance Publique - Hôpitaux de Paris, University Pierre et Marie Curie, Paris, France. bertrand.lukacs@tnn.aphp.fr
authors: Bertrand
authors: B
authors: Lukacs
authors: Jean-Nicolas
authors: JN
authors: Cornu
authors: Mounir
authors: M
authors: Aout
authors: Natacha
authors: N
authors: Tessier
authors: Christophe
authors: C
authors: Hodée
authors: François
authors: F
authors: Haab
authors: Olivier
authors: O
authors: Cussenot
authors: Yvon
authors: Y
authors: Merlière
authors: Véronique
authors: V
authors: Moysan
authors: Eric
authors: E
authors: Vicaut
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D058668:Adrenergic alpha-1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D057225:Data Mining; D016208:Databases, Factual; D011307:Drug Prescriptions; D017723:Drug Utilization Review / Q000639:trends; D005602:France / Q000453:epidemiology; D058006:General Practice / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008517:Phytotherapy / Q000639:trends; D028321:Plant Preparations / Q000009:adverse effects / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000639:trends; D064804:Urological Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014572:Urology / Q000639:trends
chemical_list: D058891:5-alpha Reductase Inhibitors; D058668:Adrenergic alpha-1 Receptor Antagonists; D028321:Plant Preparations; D064804:Urological Agents
keywords: 5α-Reductase inhibitors; Benign prostatic obstruction; Claim database; Epidemiology; Phytotherapy; Population study; α(1)-Blockers