Prescribing patterns for medical treatment of suspected prostatic obstruction: a longitudinal register-based study of the Scottish Health and Social Care Open Data

BackgroundThe diagnosis of lower urinary tract symptoms related to suspected bladder outflow obstruction from benign prostate hyperplasia/enlargement in men is increasing. This is leading to high demand on healthcare services; however, there is limited knowledge of differences in pharmacotherapy prescribing for this condition based on geography.ObjectiveTo investigate potential variation in drug prescribing for suspected bladder outflow obstruction in Scotland, based on analysis of publicly available data, to identify trends and inform future prescribing.Study designA longitudinal register-based data study of prescribing and patient data publicly available from Scottish registries. All information is available as monthly aggregates at the level of single general practices.Setting and participants903 (97%) general practices in Scotland, over a 50-month period (October 2015 to November 2019).Outcome measurements and statistical analysisWe analysed numbers of daily doses of drugs for suspected bladder outflow obstruction prescribed per month using a Bayesian Poisson regression analysis, incorporating random effects to account for spatial and temporal elements.ResultsPrescriptions for suspected bladder outflow obstruction medications increased during the observation period (overall average rate of change 1.24±0.28, ranging from 0.893 in Orkney to 1.95 in Lanarkshire). While some determinants of health inequality regarding prescribing practices across health boards are consistent with those known from the literature, other inequalities remain unexplained after accounting for practice-specific and patient-specific characteristics such as deprivation and rurality.ConclusionsInequalities in prescribing for suspected bladder outflow obstruction medications exist in Scotland, partially ascribable to accepted sociodemographic and geographic factors.

Patent urachus and bladder outflow obstruction—chance or consequence? A study of a cohort of patients with complete patent urachus presenting to a tertiary urological center and a review of literature

Background To explore the association between patent urachus and bladder outflow obstruction (BOO). A retrospective review of patient records over a 35-year period (1983–2018) with complete patent urachus was performed. Antenatal ultrasound findings were noted, and postnatal investigations included ultrasound (US), micturating cystourethrogram (MCUG), functional nuclear medicine scans (MAG3, DTPA, and DMSA), and serum creatinine. Associated anomalies and management in all patients were analyzed. Results Sixty-six patients with all types of urachal remnants were identified of whom only 16 had a patent urachus. All presented clinically with a discharging umbilicus, 10/16 confirmed on MCUG and 4 had umbilical cord cysts on antenatal US. Twenty-five percent had associated bladder outlet obstruction (BOO): etiologies included atresia of posterior urethra, congenital urethral hypoplasia, urethral atresia with prune belly syndrome, and sacrococcygeal teratoma. Vesicoureteral reflux (VUR) was confirmed in 37%, and four of them had bladder outlet obstruction (BOO). Conclusion With patent urachus, bladder outflow obstruction occurs in the minority. Based on our findings, we commend US and cystogram to document VUR. The isolated PU should be treated nonoperatively up to a year of age. Renal function should be checked with the finding of VUR. The etiopathogenesis of the condition remains uncertain.

Prioritisation of catheterised patients for elective bladder outflow obstruction surgery in the current coronavirus disease 2019 era to reduce catheter-associated morbidity

Objectives: This study aimed to audit the waiting times for a transurethral resection of prostate (TURP) at our institution, and to evaluate the extent of catheter-associated morbidity in this population. Methods: This was a retrospective closed-loop audit, with cycle one between 1 January 2018 and 31 December 2018 and cycle two between 1 October 2019 and 29 February 2020. Data collected included patient demographics, catheter status, catheter-associated presentations to accident and emergency (A&E), admissions and waiting times for TURP. The waiting-list form now has a catheter box, and a goal of 30 days from waitlisting to operation was set for those catheterised. Results: In cycle 1, 36% of the 181 patients were catheterised, and waited a median of 119 days (interquartile range (IQR) 59–163 days) for their TURP, while those not catheterised waited a median of 118 days (IQR 57.75–188.25 days). Catheterised patients presented to A&E 93 times, resulting in 13 admissions, compared to two presentations and zero admissions for those not catheterised. The median time from catheter insertion to first A&E attendance was 20 days (IQR 2–101 days). In cycle 2, 33% of the 55 patients were catheterised, with the median waiting-list time falling to 32 days (IQR 22–46 days) in those catheterised and 33 days (IQR 20–49 days) in those not catheterised. All 11 A&E attendances were from catheterised patients, with no admissions. The median time from insertion to first A&E attendance was nine days (IQR 4–40 days). Eighty-eight per cent of the waiting-list forms had appropriately ticked the catheter box. Conclusion: Our study shows that catheterised patients awaiting a TURP are more likely to have complications necessitating A&E attendance. Prioritisation of these patients on the waiting list for bladder outflow obstruction surgery may help to reduce catheter-associated morbidity. Level of evidence: Level 2c.

Prescribing patterns for medical treatment of suspected prostatic obstruction: A spatiotemporal statistical analysis of Scottish open access data

BackgroundHealthcare services treating men with prostate conditions are increasingly burdened worldwide. One of the competing factors in this demand is increasing diagnosis and treatment of lower urinary tract symptoms in men, much of which is suspected bladder outflow obstruction secondary to benign prostate hyperplasia/enlargement. However, the impact of increases on services is largely hidden, and there is limited knowledge of potential differences in management based on geography.ObjectiveTo investigate potential variation in the prescribing of drugs for suspected bladder outflow obstruction in Scotland based on analysis of publicly available data, and identify trends that may help to inform future prescribing behaviour.Design, setting, and participantsWe linked the relevant publicly available prescribing and patient data to all general practices in Scotland between October 2015 and November 2019.Outcome measurements and statistical analysisWe analysed the numbers of daily doses of drugs prescribed for suspected bladder outflow obstruction per month using a Bayesian Poisson regression analysis, incorporating random effects to account for spatial and temporal elements in prescribing.ResultsPrescriptions of drugs to treat suspected bladder outflow obstruction increased during the observation period in Scotland, consistent with an ageing population and increased diagnosis. Whilst some determinants of health inequality regarding prescribing practices across health boards are consistent with those known from the literature, other inequalities remain unexplained after accounting for practice- and patient-specific characteristics such as socio-economic deprivation and rurality.ConclusionsVariations in spatiotemporal prescribing for suspected bladder outflow obstruction exist in Scotland, some of which are unexplained and require further investigation.