Pharmacotherapy of patients with benign prostate enlargement and storage
symptoms in daily clinical practice
Abstract
Purpose: Storage symptoms significantly deteriorate the quality of life
in men with benign prostate enlargement (BPE). Muscarinic receptor
antagonists (MRAs) and β3-adrenergic receptors agonists alone, or in
combination with selective α1-alpha-antagonists (ARAs), are considered
as the most effective medicines relieving storage symptoms. The aim of
this study was to analyze pharmacotherapy of storage symptoms in men
with BPE, and their compliance with the European Association of Urology
(EAU) guidelines. Patients and methods: The survey was conducted in 2018
by 261 urologists among 37,165 outpatients with lower urinary tract
symptoms (LUTS) treated pharmacologically, including 24,613 men with BPE
(age 69 ± 8 years). Data concerning recent severity of non-neurological
LUTS and storage symptoms (urinary urgency, frequency and nocturia) and
pharmacotherapy were collected. Results: Storage symptoms were reported
by 12,356 patients (50.2%) with BPE, more frequently nocturia (75.8%),
than urinary urgency (57.8%) and urinary frequency (44.3%). Patients
with storage symptoms were more frequently prescribed with MRAs and
mirabegron (43.1% vs. 5.0%; p < 0.001; and 2.4% vs 0.3%; p
< 0.001; respectively). Of note, 54.5% of patients with
storage symptoms were treated neither with MRAs nor β3-adrenergic
receptors agonists. In the subgroup with storage symptoms, the
increasing severity of LUTS accounted for more frequent prescription of
MRA based pharmacotherapy (2.1% vs 29.1% vs 42.8% in patients with
mild, moderate, and severe LUTS, respectively). Decision tree analysis
revealed that patients with urinary urgency and urinary frequency as
well as younger ones with urinary urgency but without urinary frequency
were more frequently prescribed with MRAs. Conclusion: Urinary urgency
and frequency are associated with increased utilization of MRAs in men
with BPE in daily clinical practice. The attitude of Polish urologists
toward management of persistent storage symptoms in BPE patients is in
line with the EAU guidelines.