LAUSR

INTRODUCTION AND OBJECTIVE: Since 1994 the American Urological Association Guidelines have made testing recommendations for men with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) to identify potentially harmful related conditions like urinary retention and prostate or bladder cancer; however, our understanding of guideline adherence is limited. As part of the Urologic Diseases in America project, we assessed trends in guideline adherence for LUTS/ BPH among a large, national male population aged 40 years and older. METHODS: We analyzed two insurance claims databases: the Centers for Medicare & Medicaid Services Medicare 5% Sample for male beneficiaries aged 65 years (Nz546,000 annually) and the Optum deidentified Clinformatics Data Mart Database for privately insured males aged 40-64 years (Nz1,650,900 annually). We calculated the annual prevalence of LUTS/BPH from 2004-2013. To examine incidence of LUTS/BPH and adherence to testing guidelines, we constructed a longitudinal cohort of men newly diagnosed with the condition in 2009. RESULTS: Overall, 59% of incident LUTS/BPH patients underwent evaluation testing. While LUTS/BPH prevalence and incidence increased with patient age, evaluation testing became less common (Table 1). While urinalysis was the most commonly ordered test, it was performed in<60% of men (Figure 1). Urinalysis and PSA were more common among younger vs. older LUTS/BPH patients, whereas the opposite trend was observed for evaluation by cystoscopy and computerized tomography scan. CONCLUSIONS: Although older men are more likely to suffer from LUTS/BPH than younger men, they are less likely to undergo evaluation testing at initial diagnosis. Multiple recommended tests are not routinely ordered (i.e. urinalysis) while other testing (i.e. PSA) is used in age inappropriate men. Providers should be more cognizant of relevant AUA guidelines when assessing LUTS/BPH patients.