title: Initial treatment of men with newly diagnosed lower urinary tract dysfunction in the Veterans Health Administration.
abstract: OBJECTIVE
  To examine initial treatments given to men with newly diagnosed lower urinary tract dysfunction (LUTD) within a large integrated health care system in the United States.
  
  
  METHODS
  We used data from 2003 to 2009 from the Veteran's Health Administration to identify newly diagnosed cases of LUTD using established ICD-9CM codes. Our primary outcome was initial LUTD treatment (3 months), categorized as watchful waiting (WW), medical therapy (MT), or surgical therapy (ST); our secondary outcome was pharmacotherapy class received. We used logistic regression models to examine patient, provider, and health system factors associated with receiving MT or ST when compared with WW.
  
  
  RESULTS
  There were 393,901 incident cases of LUTD, of which 58.0% initially received WW, 41.8% MT, and 0.2% ST. Of the MT men, 79.8% received an alpha-blocker, 7.7% a 5-alpha reductase inhibitor, 3.3% an anticholinergic, and 7.3% combined therapy (alpha-blocker and 5-alpha reductase inhibitor). In our regression models, we found that age (higher), race (white/black), income (low), region (northeast/south), comorbidities (greater), prostate-specific antigen (lower), and provider (nonurologist) were associated with an increased odds of receiving MT. We found that age (higher), race (white), income (low), region (northeast/south), initial provider (urologist), and prostate-specific antigen (higher) increased the odds of receiving ST.
  
  
  CONCLUSIONS
  Most men with newly diagnosed LUTD in the Veteran's Health Administration receive WW, and initial surgical treatment is rare. A large number of men receiving MT were treated with monotherapy, despite evidence that combination therapy is potentially more effective in the long-term, suggesting opportunities for improvement in initial LUTD management within this population.
authors.affiliation: Department of Urology, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA. Electronic address: brad-erickson@uiowa.edu.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Erickson
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA.
authors.forename: Xin
authors.initials: X
authors.lastname: Lu
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA.
authors.forename: Mary
authors.initials: M
authors.lastname: Vaughan-Sarrazin
authors.affiliation: Department of Urology, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Kreder
authors.affiliation: Department of Urology, University of California, San Francisco, CA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA.
authors.forename: Peter
authors.initials: P
authors.lastname: Cram
mesh_terms: D000368:Aged; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000628:therapy*; D008297:Male; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health