title: Trends in medical management of men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia.
abstract: OBJECTIVE
  To examine trends in medical management of men with benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) in relation to sentinel events specific to particular medication regimens.
  
  
  METHODS
  Using the National Ambulatory Medical Care Survey (1993-2010), we identified outpatient visits by men with BPH/LUTS. We ascertained prescriptions for medical therapy and distinguished between treatment with alpha-blocker monotherapy, 5α reductase inhibitor monotherapy, combination therapy, and anticholinergic therapy. We evaluated temporal trends in prescription patterns and assessed for changes after sentinel events related to each regimen (eg, Food and Drug Administration [FDA] approval for tamsulosin and alpha-blocker monotherapy). Finally, we used multivariable logistic regression to determine factors associated with each treatment strategy.
  
  
  RESULTS
  From 1993 to 2010, there were over 101 million outpatient visits for men with a diagnosis of BPH/LUTS. Among these visits, the use of BPH medication increased from 14% of visits in 1993-1995 to over 40% of visits in 2008-2010 (P <.001). After tamsulosin was FDA approved, providers were twice as likely to prescribe ABs (odds ratio 2.35; 95% confidence interval 1.60-3.43). Providers were 5 times as likely to prescribe combination therapy after level 1 evidence supported its use (odds ratio 5.13; 95% confidence interval 3.35-7.86).
  
  
  CONCLUSIONS
  Over the last 15 years, there has been a steady increase in the use of medications to manage men with BPH. Providers seem to have readily adopted novel medications and treatment regimens in response to FDA approval and supportive level 1 evidence.
authors.affiliation: Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Filson
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use; D000368:Aged; D001378:Azasteroids / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D019468:Disease Management; D004359:Drug Therapy, Combination; D000068538:Dutasteride; D006801:Humans; D016015:Logistic Models; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011470:Prostatic Hyperplasia / Q000188:drug therapy*; D013449:Sulfonamides / Q000627:therapeutic use; D000077409:Tamsulosin; D064804:Urological Agents / Q000627:therapeutic use
chemical_list: D058891:5-alpha Reductase Inhibitors; D001378:Azasteroids; D018680:Cholinergic Antagonists; D013449:Sulfonamides; D064804:Urological Agents; D000077409:Tamsulosin; D000068538:Dutasteride