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-alphaantagonists (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.