title: Incidence and treatment patterns in males presenting with lower urinary tract symptoms to the emergency department in the United States.
abstract: OBJECTIVE
  Due to varying clinical definitions of lower urinary tract symptoms, it has been difficult to determine comparable prevalence and incidence rates of lower urinary tract symptoms and their treatment modalities. We assessed the incidence of emergency department visits in men with lower urinary tract symptoms who presented to emergency departments in the United States and factors associated with an increased likelihood of hospitalization.
  
  
  METHODS
  Emergency department visits from 2006 to 2009 associated with a primary diagnosis of lower urinary tract symptoms using established criteria were abstracted from the Nationwide Emergency Department Sample. Age adjusted incidence rates of emergency department visits and charges were calculated. We performed multivariable analysis to examine patient and hospital characteristics of those hospitalized and those with benign prostatic hyperplasia related adverse events.
  
  
  RESULTS
  A weighted estimate of 1,178,423 emergency department visits for lower urinary tract symptoms was recorded with a national incidence of 197.6/100,000 males per year. A total of 112,288 visits (9.5%) resulted in hospitalization. Adverse events were identified in 734,269 patients (62.3%). The most common adverse events were catheterization in 44.6% of cases, infection in 17.4%, hematuria in 9.6%, bladder stones in 1.7%, hydronephrosis in 1.2% and acute renal failure in 0.1%. On multivariable analysis independent predictors of hospital admission included comorbidities, socioeconomic status, hospital characteristics and adverse events such as sepsis, acute renal failure and hydronephrosis. Independent predictors of adverse events included patient age, year of visit, socioeconomic status, hospital characteristics and concomitant neurological disease. In 2009 total emergency department charges for lower urinary tract symptoms were $494,981,922.
  
  
  CONCLUSIONS
  The number of men with lower urinary tract symptoms who visit the emergency department has remained stable, while emergency department charges have increased by 40%. The rate of adverse events increased during the study period. These findings might suggest over reliance on medical and conservative therapy in the contemporary era.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany. Electronic address: f.roghmann@gmail.com.
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.forename: Naeem
authors.initials: N
authors.lastname: Bhojani
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.forename: Vincent
authors.initials: V
authors.lastname: Trudeau
authors.forename: Andreas
authors.initials: A
authors.lastname: Becker
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
authors.forename: Pierre
authors.initials: P
authors.lastname: Karakiewicz
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D059411:Lower Urinary Tract Symptoms / Q000150:complications / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States
keywords: AE; ARF; BPH; CCI; CT; Charlson comorbidity index; EAPC; ED; LUTS; MRI; NEDS; Nationwide Emergency Department Sample; TRUS; acute renal failure; adverse event; benign prostatic hyperplasia; complications; computerized tomography; emergencies; emergency department; estimated annual percent change; lower urinary tract symptoms; magnetic resonance imaging; prostate; prostatic hyperplasia; transrectal ultrasound