Evaluation and management of male lower urinary tract symptoms: treatment patterns and guidelines in a correlation study among Polish urology consultants

Abstract

IntroductionIn March 2013, the European Association of Urology (EAU) released a new edition of the guidelines on management of male lower urinary tract symptoms (LUTS), including benign prostatic obstruction. The objective of this study was to evaluate how well the EAU guidelines have been implemented in day-to-day practice by Polish urologists.Material and methodsA structured questionnaire, which explored how urologists diagnose and manage male lower urinary tract symptoms, was emailed to all certified, actively practicing urologists from a list provided by the Polish Urological Association.ResultsThe questionnaire return rate was 33.7% (135/400). Overall, the median (quartile 1; quartile 3) frequency of correct answers was 65.0% (58.0%; 69.0%). Analysis of the association of availability and acceptance of the EAU guidelines with question answers showed no pattern. A multivariate regression model showed a positive correlation with regards to correct answers given in the survey and doctors’ participation in international congresses (p = 0.018, r = 0.181). Basket analysis showed the strongest association for those who failed to correctly answer the questions regarding diagnosis of LUTS and overactive bladder (OAB) (support = 27.41%, confidence = 86.05%).ConclusionsAlthough there is a significant degree of adherence to the 2013 EAU guidelines, some discrepancies between urologists’ practice and the recommendations regarding diagnosis and treatment of male LUTS do exist. The data obtained provide valuable benchmarks and also identify possible interventions that may improve the standard of care in this population of patients.

Pharmacotherapy of patients with benign prostate enlargement and storage symptoms in daily clinical practice

“…Our real-life data concerning current pharmacotherapy for benign prostate enlargement (BPE) shows that ARAs monotherapy remains as the most frequent therapeutic option utilized in more than one-third of patients. It is in line with the survey performed among Polish urologists, showing that ARAs in monotherapy was the first line option for patients with and even without BPE [13]. When comparing the prescribed medication for non-neurogenic LUTS with the data coming from PolSenior study [15], performed in years 2007 -2012, one may see that the prescription of ARAs in monotherapy has declined from 64.7 to 25.6%, during last years, possibly as a consequence of later guidelines from 2010.…”

“…In parallel, during this period of time there was an increase in the utilisation of ARA+5αRI combined therapy from 21.9% to 30.9% and most spectacularly the use of MRAs (in the combined therapy) from 1.7 to 23.6%. The increase in the utilization of MRAs, revealed by our observation, is in line with the treatment option accepted by 83.7% of Polish urologists concerning MRAs use for the management of storage LUTS [13]. While the most recently introduced drug -mirabegron is currently rarely used (1.4% of overall study population and 2.4% of those with storage symptoms), probably due to the lack of reimbursement from Polish National Health Fund.…”

“…ARAs were the first line treatment option both for patients with (48.8% urologists) and without (84.8% urologists) benign prostate enlargement (BPE) while only 17.1% urologists were choosing 5αRIs in monotherapy, and 29.6% prescribed them with ARAs as the primary treatment. MRAs were an acceptable treatment option for storage LUTS in the opinion of 83.7% of urologists [13]. This survey assessed the urologists declarations concerning therapy, but did not verify their daily prescribing practice.…”

Management of rheumatoid arthritis in Poland – where daily practice might not always meet evidence-based guidelines

“…Data regarding guideline adherence are important because they provide comparative benchmarks and identify potential areas of intervention [2]. In concordance with "treat-to-target" principles [3], evidence-based European League Against Rheumatism (EULAR) guidelines for rheumatoid arthritis (RA) advocate early and individualized treatment [4].…”

“…Early studies have indicated that approximately half of patients receive the recommended care in chronic conditions, and this remains true when considering screening, diagnosis, treatment and follow-up [ 1 ]. Data regarding guideline adherence are important because they provide comparative benchmarks and identify potential areas of intervention [ 2 ]. In concordance with “treat-to-target” principles [ 3 ], evidence-based European League Against Rheumatism (EULAR) guidelines for rheumatoid arthritis (RA) advocate early and individualized treatment [ 4 ].…”