The cost of lifelong LUTS-A systematic literature review.

BACKGROUND: Lower urinary tract symptoms (LUTS) are highly prevalent and very bothersome. To support the best possible allocation of health care resources and to avoid unnecessary expenditures, it is important to understand and quantify the wide-ranging health care costs affecting people suffering from LUTS. We aimed at creating a foundation for exploring the cost of LUTS. METHOD: In this systematic literature review, we explored the costs of illness of the LUTS umbrella. We used the online literature review tool Silvi.ai for transparent decision-making and literature management. RESULTS: A total of 1821 original articles were screened. Forty had explored the cost of illness of a LUTS disease since 2013. The studies were conducted in 18 countries. A number of different study designs were applied, including both retrospective and prospective studies. In total, seven LUTS indications were explored. None of them focused on lifelong LUTS. None of them were conducted in infants or children. Eighty-two percent were conducted in adults and 18% in frail elderly. Most cost of illness studies focused on the cost of hospitalization and use of medicine. CONCLUSION: We have created the groundwork for understanding the cost of LUTS illness. To fully understand the cost of illness of lifelong LUTS, the main gap in research is to investigate the cost of LUTS in infants and children.

What Is New with Rezum Water Vapor Thermal Therapy for LUTS/BPH?

PURPOSE OF REVIEW: Rezum® is a novel convection-based thermal therapy for benign prostatic hyperplasia (BPH) induced lower urinary tract symptoms (LUTS). This review provides an overview of its safety, efficacy, cost, and potential role in the paradigm of BPH/LUTS therapies. RECENT FINDINGS: Data regarding Rezum® stems primarily from one large randomized controlled trial of 197 patients with 4 years of follow-up. The efficacy and safety of Rezum® is further supported by 4 additional studies including 1 prospective pilot study, 1 crossover study, and 2 retrospective studies. Durable improvements in IPSS (47-60%), QoL (38-52%), Qmax (45-72%), and PVR (11-38%) were seen without causing deterioration of sexual function. Rezum® offers a cost-effective and safe approach to treating BPH/LUTS and should be considered as a possible first-line therapy for patients with moderate to severe symptoms.

Underrepresentation of functional conditions of the lower urinary tract in adults in US federal research funding.

AIMS: Evaluation and treatment of functional conditions of the lower urinary tract (fcLUT), a subset of benign urinary tract conditions, is highly subjective due to overlapping symptomatology. Despite high prevalence and socioeconomic cost, there has been little improvement in their treatment and lack of progress in understanding their pathophysiology. This study investigates trends in quantity, monetary amounts, and awardees' characteristics of federally funded research awards for fcLUT compared to nonurologic benign conditions (NUBCs) and urologic malignancies. METHODS: Data were extracted from the National Institutes of Health (NIH) and federal RePORTER databases in December 2019. We identified currently active awards in fcLUT, NUBC, and malignant urologic conditions and the associated demographic features of awardees. The authors also examined temporal funding trends for such awards. RESULTS: These database searches revealed that there are consistently fewer awards and funding dollars for the study of fcLUT compared to other benign conditions with similar prevalences. While most research topics have received increased funding in awards and overall funding dollars over time, fcLUT funding has remained relatively flat. Urologists are also underrepresented; only 11 of the 86 recipients of NIH R01 awards to study fcLUT have clinical training in urology. CONCLUSIONS: Even when compared to NUBC, funding for the study of fcLUT remains low and has stagnated over time. Further, investigators who are clinicians in the field of urology are in the minority of those doing this study. Given the need for clinical perspectives in fcLUT research, the lack of urologist representation will inhibit discovery and translational advances.

The relationship between prevalence and severity of lower urinary tract symptoms (LUTS), and body mass index and mid-abdominal circumference in men in a resource-poor community in Southeast Nigeria: a cross-sectional survey.

BACKGROUND: There is paucity of information on the community-based prevalence and severity of lower urinary tract symptoms (LUTS) in men who are 40 years and older in the southeast region of Nigeria. This study seeks to determine the community-based prevalence of LUTS and the relationship between LUTS, and body mass index (BMI) and mid-abdominal circumference (MAC) in men. METHODS: An interviewer-administered, questionnaire-based survey. Three of nine settlement clusters were randomly selected while systematic random sampling of 1 in 3 eligible subjects was used to select participants. Analysis was done using SPSS® version 20. RESULTS: One thousand three hundred and nineteen duly completed questionnaires were analyzed. The respondents are within ages 40-92 years with mean age 54.2 ± 10.2 years, mean BMI 25.97 ± 4.18Kg/m2 and mean MAC 89.80 ± 12.43 cm. Overall prevalence of LUTS is 20.2%. Nocturia at a prevalence of 19.2% is the most prevalent lower urinary tract symptom and also the earliest to manifest. LUTS prevalence and severity increases with increasing age. About 9.6% report moderate LUTS while 2.3% report severe LUTS. Storage LUTS are reported more frequently than voiding LUTS. LUTS did not vary significantly with BMI, MAC or Wealth-Index. CONCLUSION: LUTS prevalence and severity vary with age, but not with BMI, MAC or Wealth-Index.

[Economic aspects of treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia].

A review of the literature dedicated to the economic aspects of drug and surgical treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is presented in the article. Currently, symptomatic therapy, which usually leads to an increase in the financial costs associated with the complications and surgical treatment, is most commonly used. The pathogenetic treatment of BPH (5-alpha reductase inhibitors), including combination therapy, requires an increase in costs, but it is also considered the most cost-effective approach. Despite the continuous growing of therapeutic armamentarium, the surgical treatment is still relevant and holds an important place. A lot of studies have shown that open procedures are inferior to endoscopic and minimally invasive interventions by both clinical and cost-effective results. At the same time, transurethral interventions on the prostate does not exclude economic losses due to the necessity of expensive laser technologies and the development of complications in the early postoperative period. Thus, currently, the best treatment option should be chosen not only on individual basis, but also depending on economic aspects based on a balanced medical and economic analysis of each treatment method.

[Cost-effectiveness model of a fixed dose combination of solifenacin and tamsulosin for the treatment of LUTS associated with BPH with inadequate response to monotherapy.] / Modelo de coste­efectividad de la combinación a dosis fijas de solifenacina y tamsulosina en el tratamiento de los STUI asociados a HBP con respuesta inadecuada a la monoterapia.

OBJECTIVE: To compare the cost-effectiveness of fixed dose combination of solifenacin 6 mg and tamsulosin 0.4 mg in a controlled absorption system (TOCAS) with free dose combination of tolterodine plus tamsulosin, when used for the treatment of patients with moderate to severe lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) who do not respond adequately to monotherapy. The analysis was conducted from the perspective of the Spanish National Health System. METHODS: A Markov model was developed in Excel, with 1-year time horizon. The transition probabilities of the model were obtained from the NEPTUNE clinical trial and published literature. Unit costs were obtained from Spanish sources. The use of healthcare resources was validated by Spanish clinical experts. Both deterministic and probabilistic analyses were performed to determine the key drivers of the model. RESULTS: Treatment with fixed dose combination of solifenacin plus TOCAS was found to be dominant, as it resulted in lower annual costs (€ 1,349 vs. € 1,619) and greater quality-adjusted life years (QALY) gained per patient (0.8406 vs. 0.8386) when compared with free dose combination of tolterodine plus tamsulosin. According to the probabilistic analyses, the probability of the fixed dose combination treatment being cost-effective at a willingness to pay threshold of € 20,000 or 30,000 would be 100%. CONCLUSIONS: This analysis suggests that fixed dose combination of solifenacin plus TOCAS represents a cost-effective choice for the treatment of patients with moderate to severe LUTS/BHP, compared to free dose combination of tolterodine plus tamsulosin.

Ureteral stent removal using an extraction string after uncomplicated ureteroscopy: a cost-benefit analysis.

PURPOSE: Some urologists used the extraction strings for removal of ureteral stent without cystoscopy. While some urologists may have concern about perceived risks, including accidental dislodgement, infection, renal?colic?and lower urinary tract symptoms. Therefore, we performed a retrospective study to help address this conflict. MATERIALS AND METHODS: Patients who had an indwelling ureteral stent with(n=58) or without(n=82) extraction strings inserted after ureteroscopy for unilateral ureteral stones were enrolled. For ureteral stent removal, the strings were pulled by physician, no string-stents were removed by cystoscopic. Postoperative morbidity was assessed. Patients' medical expense due to postoperative morbidity was collected. RESULTS: Patients with extraction string had shorter stent dwell time((5.3±1.8 versus 11.2±3.2 day, P= .001)  and  less cost (8.97±3.07 versus 455±0 CNY, P = .001)) for ureteral stent removal. However, six patients with extraction string had an accidental dislodgement, additional medical expenses were 345±137.9 CNY. There was no difference in the cost due to urinary tract infection, renal?colic?and LUTS between the two groups. The overall cost in patients without an extraction string was significantly more than in patients with an extraction string (86.7±167.7 versus 507.9±147.8 CNY, p =.008). CONCLUSION: Despite an increase in stent dislodgement related risks  to the extraction string, it results in significant cost savings for patients, and most of patients remove with extraction strings might benefit from it.  INTRODUCTION Nowadays, most of urologists place an indwelling ureteral stent following uncomplicated ureteroscopy(URS). However, ureteral stent may impact quality of life (QoL) of patients. And the additional suffering due to cystoscopic extraction is even more painful. Current ureteral stents are manufactured with a string attached to the distal end, allowing for removal without cystoscopy, which may lead to a reduction of the dwell time(usually less than one week)[1-8]. Although stent extraction strings have many advantages, more than two-thirds of urologists remove extraction strings prior to their insertion[9]. Surgeons who do not adopt?this?method?may have concern about perceived risks, including accidental dislodgement, infection, renal?colic?and lower urinary tract symptoms(LUTS). But how about incidence?rate of the risk aforementioned??does this increase the patient's financial burden compared with patients remove without extraction strings? Whether patients remove with extraction strings might benefit from it? Therefore, we performed a retrospective study to help address these questions by comparing patients those who underwent ureteric stent placement with and without extraction strings after URS for stone disease.

Modelo de coste-efectividad de la combinación a dosis fijas de solifenacina y tamsulosina en el tratamiento de los STUI asociados a HBP con respuesta inadecuada a la monoterapia / Cost-effectiveness model of a fixed dose combination of solifenacin and tamsulosin for the treatment of LUTS associated with BPH with inadequate response to monotherapy

OBJETIVO: Evaluar el coste-efectividad de la combinación a dosis fijas de 6 mg de solifenacina y 0,4 mg de tamsulosina en un sistema oral de absorción controlada (TOCAS) en el tratamiento de los pacientes con síntomas del tracto urinario inferior (STUI) moderados a graves asociados a la hiperplasia benigna de próstata (HBP) (STUI/HBP) y una respuesta inadecuada a la monoterapia, en comparación con el tratamiento de tolterodina más tamsulosina, desde la perspectiva del Sistema Nacional de Salud (SNS). MÉTODOS: Se realizó un modelo de Markov en Excel con un horizonte temporal de 1 año. Las probabilidades de transición del modelo se obtuvieron del ensayo clínico NEPTUNE y la literatura. Los costes unitarios se obtuvieron de fuentes españolas. El uso de recursos sanitarios fue validado por expertos clínicos españoles. Se realizaron análisis determinísticos y probabilísticos. RESULTADOS: El tratamiento con la combinación a dosis fijas de solifenacina más TOCAS dio lugar a un menor coste anual (1.349 Euros vs. 1.619 Euros) y un aumento de años de vida ajustados por su calidad (AVAC) (0,8406 vs. 0,8386) por paciente en comparación con tolterodina más tamsulosina, siendo por tanto dominante. La probabilidad de que el tratamiento a dosis fijas de solifenacina más TOCAS sea coste-efectivo frente al tratamiento con tolterodina más tamsulosina sería del 100% para una disponibilidad a pagar de 20.000-30.000 Euros por AVAC ganado. CONCLUSIONES: El tratamiento con dosis fijas de solifenacina más TOCAS en pacientes con STUI/HBP moderados a graves daría lugar a una ganancia de AVAC, siendo una estrategia coste-efectiva y dominante frente al tratamiento con tolterodina más tamsulosina

OBJECTIVE: To compare the cost-effectiveness of fixed dose combination of solifenacin 6 mg and tamsulosin 0.4 mg in a controlled absorption system (TOCAS) with free dose combination of tolterodine plus tamsulosin, when used for the treatment of patients with moderate to severe lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) who do not respond adequately to monotherapy. The analysis was conducted from the perspective of the Spanish National Health System. METHODS: A Markov model was developed in Excel, with 1-year time horizon. The transition probabilities of the model were obtained from the NEPTUNE clinical trial and published literature. Unit costs were obtained from Spanish sources. The use of healthcare resources was validated by Spanish clinical experts. Both deterministic and probabilistic analyses were performed to determine the key drivers of the model. RESULTS: Treatment with fixed dose combination of solifenacin plus TOCAS was found to be dominant, as it resulted in lower annual costs (Euros 1,349 vs. Euros 1,619) and greater quality-adjusted life years (QALY) gained per patient (0.8406 vs. 0.8386) when compared with free dose combination of tolterodine plus tamsulosin. According to the probabilistic analyses, the probability of the fixed dose combination treatment being cost-effective at a willingness to pay threshold of Euros 20,000 or 30,000 would be 100%. CONCLUSIONS: This analysis suggests that fixed dose combination of solifenacin plus TOCAS represents a cost-effective choice for the treatment of patients with moderate to severe LUTS/BHP, compared to free dose combination of tolterodine plus tamsulosin

A critical appraisal of the principal guidelines for neurogenic lower urinary tract dysfunction using the AGREE II instrument.

AIMS: The process of identifying research questions, synthesizing and interpreting evidence, and weight given to health economics differs between the clinical guidelines (CGs) for neurogenic lower urinary tract dysfunction (NLUTD). Consequently, the quality also varies which can have implications for clinical practice. METHODS: We used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to assess the quality of the National Institute for Health and Care Excellent (NICE), European Association of Urology (EAU), and the International Consultations on Incontinence (ICI) CGs on neurogenic bladder. RESULTS: The NICE CGs were deemed to be of the highest quality (overall score of 92%). NICE were the only guidelines to systematically incorporate cost-effectiveness research into their recommendations. The EAU CGs received an overall score of 83% and the ICI CGs achieved the lowest overall score (75%). The highest scoring domain among all the CGs was scope purpose (86%) and the lowest scoring domain was applicability (69%). All guidelines were recommended for use (mostly with some modifications). CONCLUSIONS: All CGs had their inherent advantages and disadvantages, though all were still deemed to be of high quality. Incorporating cost-effectiveness research would be near impossible for guidelines with a broad-country remit. Incorporating the AGREE II instrument in the development of CGs and better collaboration between the ICI, NICE, and EAU could improve the quality, and consistency between NLUTD CGs and ultimately improve health outcomes for this important patient group.

Diagnóstico y tratamiento del paciente varón con síntomas del tracto urinario inferior en España - Estudio MERCURY. ¿Seguimos los urólogos las recomendaciones de las guías europeas? / Diagnosis and treatment of male patients with lower urinary tract symptoms in Spain - The MERCURY Study. Do urologists follow the recommendations of the European guidelines?

Objetivos: Conocer el manejo de pacientes varones con síntomas del tracto urinario inferior (STUI) y evaluar el seguimiento de las recomendaciones de las guías de la Asociación Europea de Urología en España. Material y métodos: El estudio MERCURY, epidemiológico y transversal, con 227 unidades de urología participantes en España, evaluó a pacientes varones con STUI mixtos predominantemente de llenado, de los cuales se recogió información sociodemográfica, clínica y de consumo de recursos de los 6 meses anteriores. Adicionalmente, mediante un caso clínico teórico, los investigadores describieron su actitud sobre el manejo de los STUI mixtos con predominio de llenado persistentes tras un tratamiento inicial, en cuanto a pruebas diagnósticas y aproximación terapéutica en la primera y la segunda visita. Las opciones proporcionadas para el manejo de los STUI estaban alineadas con las recomendaciones de la Asociación Europea de Urología. Resultados: Se evaluaron 610 pacientes, de los cuales el 87,7% consumió algún recurso sanitario debido a: visitas al urólogo (79,7%), determinación del PSA (76,6%) y tratamiento con alfabloqueante (37,5%) y alfabloqueante más antimuscarínico (37,2%). En el caso clínico teórico, la actitud del urólogo en la elección de pruebas diagnósticas y tratamiento farmacológico fue principalmente: determinación del PSA (97,7%), tacto rectal (91,4%) y tratamiento con alfabloqueantes en monoterapia (56,6%) en la primera visita; flujometría (48,9%), diario miccional (40,3%) y tratamiento con alfabloqueante más antimuscarínico (70,6%) en la segunda visita. Conclusiones: La actitud de los urólogos en España para el manejo del paciente varón con STUI mixtos predominantemente de llenado se ajusta a las recomendaciones de las guías clínicas europeas

Objectives: To explore the management of lower urinary tract symptoms (LUTS) in men in Spain and assess the compliance with recommendations established in the European Association of Urology (EAU) guidelines. Material and methods: MERCURY was an epidemiological and cross-sectional study which involved 227 Urology Units across Spain assessing adult male patients with mixed LUTS and persisting storage symptoms. Sociodemographic, clinical and resource use data for the 6 months prior to study inclusion were collected. Additionally, through a theoretical clinical case, clinicians described their attitude toward the diagnostic and therapeutic management of males with mixed LUTS and persisting storage symptoms during the first and second visits. Answer options given to clinicians about LUTS management were aligned with those recommended by EAU guidelines. Result: 610 patients included in the study were evaluated. 87.7% of them consumed some health resource mainly due to: urologist visits (79.7%), PSA determination (76.6%) and treatment with alpha-blockers (37.5%) and alpha-blockers plus antimuscarinics (37.2%). According to the theoretical clinical case, urologists preference toward diagnostic tools and pharmacological treatment in first visit were mainly PSA determination (97.7%), digital rectal examination (91.4%) and treatment with alphablockers as monotherapy (56.6%), whereas in the second visit uroflowmetry (48.9%), voiding diary (40.3%) and treatment with alpha-blockers plus antimuscarinics (70.6%) were mainly preferred. Conclusions: Urologists attitude toward management of male patients with mixed LUTS and persisting storage symptoms is aligned with that recommended in the EAU guidelines

Healthcare resource utilization and cost among males with lower urinary tract symptoms with a predominant storage component in Spain: The epidemiological, cross-sectional MERCURY study.

AIMS: To assess the relationship between storage-predominant LUTS and healthcare resource consumption and cost among males in Spain. METHODS: In this non-interventional, cross-sectional study, urologists enrolled males with storage-predominant LUTS and recorded the consumption of healthcare resources (medical visits, diagnostic tests/monitoring, treatment, and hospitalizations) within the previous 6 months. The cost of healthcare resources was calculated from unit costs extracted from a Spanish eHealth database. Severity of LUTS was assessed by the Bladder Self-Assessment Questionnaire (BSAQ) and patients were stratified by symptom score (<6 or ≥6) to assess the relationship between LUTS severity and healthcare resource consumption and cost. RESULTS: Among 610 enrolled patients (BSAQ symptom score <6, n = 191; BSAQ symptom score ≥6, n = 419), the majority (87.7%) consumed healthcare resources during the previous 6 months in the form of medical visits (86.2%), diagnostic tests/monitoring (83.4%), and treatment (85.9%). Patients with BSAQ symptom scores ≥6 used more healthcare resources compared with patients with BSAQ symptom scores <6. The most common treatments for LUTS were α-blockers used as monotherapy (n = 229 [37.5%]) or in combination with antimuscarinics (n = 227 [37.2%]). The estimated median annual cost was €1070 per patient, consisting of diagnostic tests/monitoring (54.6%), medical visits (20.5%), and treatment (29.6%), and was higher in patients with BSAQ symptom score ≥6 (€1127) than in patients with BSAQ symptom score <6 (€920; P < 0.001). CONCLUSIONS: More severe LUTS are associated with higher healthcare consumption and cost. These findings highlight the importance of symptom management in LUTS patients to help minimize healthcare consumption and cost.

International Prostate Symptom Score Should Be Considered a Complement Rather Than a Substitute to Generic Preference-Based Measures for Measuring Lower Urinary Tract Symptoms Within Economic Evaluation.

OBJECTIVE: To determine the suitability of using the International Prostate Symptom Score (IPSS), a condition-specific instrument, within economic evaluation of lower urinary tract symptom (LUTS) interventions. METHODS: Data were obtained from a cohort of 2236 community-dwelling Australian men. Using correlations and a modified Bland-Altman plot, we investigated the convergent validity of the IPSS with two generic quality of life (GQol) instruments: the Assessment of Quality of Life 4 Dimensions (AQoL-4D) and the Short-Form 36 (SF-36). Discriminant validity was investigated using Wilcoxon-Mann-Whitney and Kruskal-Wallis tests, comparing instrument scores and utilities between subgroups varying in age, marital status, history of illness, smoking status and self-assessed general health. RESULTS: Discriminant validity was confirmed for all instruments by finding statistically significant differences in summary scores and utilities between nearly all subgroups. Convergent validity between the summary scores/utilities of the IPSS and the GQoL instruments was weak (absolute correlation value range, 0.11-0.23) but differed considerably between dimensions of the instruments (absolute correlation value range, 0.01-0.24). Weak to moderate correlation between the GQoL instruments was seen (absolute correlation value range, 0.01-0.49). CONCLUSION: Our findings suggest that the IPSS has comparable discriminant validity to the GQoL instruments and therefore useful for assessing subgroup differences related to urinary symptoms. The weak convergence between the IPSS and the GQoL instruments however suggests that, within economic evaluation, the IPSS should be viewed as a complement rather than a substitute to the GQoL instruments because it captures different quality of life constructs.

Understanding the Economic Impact of Neurogenic Lower Urinary Tract Dysfunction.

Neurogenic bladder is a chronic and disabling condition associated with multiple comorbidities and a widespread economic impact. Literature on cost of care and resource utilization is sparse and heterogeneous. Nonstandardized approaches, impact perspectives, and types of costs are used to describe the economic implications of neurogenic bladder. The financial toll is difficult to ascertain due to indirect and intangible costs exacerbated by the underlying disability. Health resource utilization based on clinical manifestations of neurogenic bladder may serve as an alternative measure. Understanding the multifold economic implications and health resource utilization patterns of neurogenic bladder may guide improvement of treatment strategies.

Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) - focus on the UK.

KEY MESSAGES: Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) can be bothersome and negatively impact on a patient's quality of life (QoL). As the prevalence of LUTS/BPH increases with age, the burden on the healthcare system and society may increase due to the ageing population. This review unifies literature on the burden of LUTS/BPH on patients and society, particularly in the UK. LUTS/BPH is associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning, and through its negative impact on QoL for patients and partners. LUTS/BPH is often underdiagnosed and undertreated. Men should be encouraged to seek medical advice for this condition and should not accept it as part of ageing, while clinicians should be more active in the identification and treatment of LUTS/BPH. To assess the burden of illness and unmet need arising from lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH) from an individual patient and societal perspective with a focus on the UK. Embase, PubMed, the World Health Organization, the Cochrane Database of Systematic Reviews and the York Centre for Reviews and Dissemination were searched to identify studies on the epidemiological, humanistic or economic burden of LUTS/BPH published in English between October 2001 and January 2013. Data were extracted and the quality of the studies was assessed for inclusion. UK data were reported; in the absence of UK data, European and USA data were provided. In all, 374 abstracts were identified, 104 full papers were assessed and 33 papers met the inclusion criteria and were included in the review. An additional paper was included in the review upon a revision in 2014. The papers show that LUTS are common in the UK, affecting ≈3% of men aged 45-49 years, rising to >30% in men aged ≥85 years. European and USA studies have reported the major impact of LUTS on quality of life of the patient and their partner. LUTS are associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning. While treatment costs in the UK are relatively low compared with other countries, the burden on health services is still substantial. LUTS associated with BPH is a highly impactful condition that is often undertreated. LUTS/BPH have a major impact on men, their families, health services and society. Men with LUTS secondary to BPH should not simply accept their symptoms as part of ageing, but should be encouraged to consult their physicians if they have bothersome symptoms.

Multicenter study on costs associated with two surgical procedures: GreenLight XPS 180 W versus the gold standard transurethral resection of the prostate.

OBJECTIVE: To analyze the costs associated with two surgical procedures for lower urinary tract symptoms secondary to benign prostatic hyperplasia: GreenLight XPS 180¦W versus the gold standard transurethral resection of the prostate. METHODS: A multicenter, retrospective cost study was carried out from the National Health Service perspective, over a 3-month time period. Costs were broken down into pre-surgical, surgical and post-surgical phases. Data were extracted from records of patients operated sequentially, with IPSS=15, Qmax=15 mL/seg and a prostate volume of 40-80mL, adding only direct healthcare costs (€, 2013) associated with the procedure and management of complications. RESULTS: A total of 79 patients sequentially underwent GL XPS (n: 39) or TURP (n: 40) between July and October, 2013. Clinical outcomes were similar (94.9% and 92.5%, GL XPS and TURP, respectively) without significant differences (P=.67). The average direct cost per patient was reduced by €114 in GL XPS versus TURP patients; the cost was higher in the surgical phase with GL XPS (difference: €1,209; P<.001) but was lower in the post-surgical phase (difference: €-1,351; P<.001). CONCLUSIONS: The GreenLight XPS 180-W laser system is associated with a reduction in costs with respect to transurethral resection of prostate in the surgical treatment of LUTS secondary to PBH. This reduction is due to a shorter inpatient length of stay that offsets the cost of the new technology.

Incidence and treatment patterns in males presenting with lower urinary tract symptoms to the emergency department in the United States.

PURPOSE: Due to varying clinical definitions of lower urinary tract symptoms, it has been difficult to determine comparable prevalence and incidence rates of lower urinary tract symptoms and their treatment modalities. We assessed the incidence of emergency department visits in men with lower urinary tract symptoms who presented to emergency departments in the United States and factors associated with an increased likelihood of hospitalization. MATERIALS AND METHODS: Emergency department visits from 2006 to 2009 associated with a primary diagnosis of lower urinary tract symptoms using established criteria were abstracted from the Nationwide Emergency Department Sample. Age adjusted incidence rates of emergency department visits and charges were calculated. We performed multivariable analysis to examine patient and hospital characteristics of those hospitalized and those with benign prostatic hyperplasia related adverse events. RESULTS: A weighted estimate of 1,178,423 emergency department visits for lower urinary tract symptoms was recorded with a national incidence of 197.6/100,000 males per year. A total of 112,288 visits (9.5%) resulted in hospitalization. Adverse events were identified in 734,269 patients (62.3%). The most common adverse events were catheterization in 44.6% of cases, infection in 17.4%, hematuria in 9.6%, bladder stones in 1.7%, hydronephrosis in 1.2% and acute renal failure in 0.1%. On multivariable analysis independent predictors of hospital admission included comorbidities, socioeconomic status, hospital characteristics and adverse events such as sepsis, acute renal failure and hydronephrosis. Independent predictors of adverse events included patient age, year of visit, socioeconomic status, hospital characteristics and concomitant neurological disease. In 2009 total emergency department charges for lower urinary tract symptoms were $494,981,922. CONCLUSIONS: The number of men with lower urinary tract symptoms who visit the emergency department has remained stable, while emergency department charges have increased by 40%. The rate of adverse events increased during the study period. These findings might suggest over reliance on medical and conservative therapy in the contemporary era.

Changes in initial expenditures for benign prostatic hyperplasia evaluation in the Medicare population: a comparison to overall Medicare inflation.

PURPOSE: Benign prostatic hyperplasia creates significant expenses for the Medicare program. We determined expenditure trends for benign prostatic hyperplasia evaluative testing after urologist consultation and placed these trends in the context of overall Medicare expenditures. MATERIALS AND METHODS: Using a 5% national sample of Medicare beneficiaries from 2000 to 2007 we developed a cohort of 40,253 with claims for new visits to urologists for diagnoses consistent with symptomatic benign prostatic hyperplasia. We assessed trends in initial inflation and geography adjusted expenditures within 12 months of diagnosis by evaluative test categories derived from the 2003 American Urological Association guideline on the management of benign prostatic hyperplasia. Using governmental reports on Medicare expenditure trends for benign prostatic hyperplasia we compared expenditures to overall and imaging specific Medicare expenditures. Comparisons were assessed by the Z-test and regression analysis for linear trends, as appropriate. RESULTS: Between 2000 and 2007 inflation adjusted total Medicare expenditures per patient for the initial evaluation of patients with benign prostatic hyperplasia seen by urologists increased from $255.44 to $343.98 (p <0.0001). Benign prostatic hyperplasia related imaging increases were significantly less than overall Medicare imaging expenditure increases (55% vs 104%, p <0.001). The increase in per patient expenditures for benign prostatic hyperplasia was significantly lower than the increase in overall Medicare expenditures per enrollee (35% vs 45%, p = 0.0015). CONCLUSIONS: From 2000 to 2007 inflation adjusted expenditures increased for benign prostatic hyperplasia related evaluations. This growth was slower than the overall growth in Medicare expenditures. The increase in BPH related imaging expenditures was restrained compared to that of the Medicare program as a whole.