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

TY - JOUR

T1 - Incidence and treatment patterns in males presenting with lower urinary tract symptoms to the emergency department in the United States

AU - Roghmann, Florian

AU - Ghani, Khurshid R

AU - Kowalczyk, Keith J

AU - Bhojani, Naeem

AU - Sammon, Jesse D

AU - Gandaglia, Giorgio

AU - Trudeau, Vincent

AU - Becker, Andreas

AU - Sukumar, Shyam

AU - Menon, Mani

AU - Zorn, Kevin C

AU - Karakiewicz, Pierre

AU - Sun, Maxine

AU - Noldus, Joachim

AU - Trinh, Quoc-Dien

N1 - Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

PY - 2013/11/1

Y1 - 2013/11/1

N2 - 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.

AB - 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.

KW - Aged

KW - Costs and Cost Analysis

KW - Emergency Service, Hospital

KW - Hospitalization

KW - Humans

KW - Incidence

KW - Lower Urinary Tract Symptoms

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - United States

U2 - 10.1016/j.juro.2013.05.112

DO - 10.1016/j.juro.2013.05.112

M3 - SCORING: Journal article

C2 - 23764070

VL - 190

SP - 1798

EP - 1804

JO - J UROLOGY

JF - J UROLOGY

SN - 0022-5347

IS - 5

ER -