Presented by: Ijeoma Nnorom MBBS, MRCS
King's College Hospital London

Introduction

This study aims to compare the prescribing choices of medications for male lower urinary tract symptoms (LUTS) to self-administration preferences of Urologists and associated practitioners across the globe. The medications included in the survey are recommended by guidelines including European Associsation of Urology, British Association of Urology, as well as North American sources.

There is a paucity of data regarding the physicians' take on these medications in light of existing data on efficacy and side effect profile, as well as (guideline) recommendations for their use. The personal (self prescription) preferences discovered may throw some light on clinicians' approval of these medicines.

We also wanted to assess the tendencies of our colleagues in other parts of the globe who may use a different set of guidelines and/or have a varying array of medications accessible in comparison to those commonly used in United Kingdom (UK) practice.

Materials

An electronic survey of Urologists and allied practitioners, practicing within the United Kingdom (UK) and globally was conducted.. On a 10-point Likert scale, respondents were asked 3 questions about these medications:

‘Likelihood of prescribing’; the ‘perceived efficacy’, and ‘the likelihood of the respondent taking them’.

10 medications from a total of 5 drug classes were looked at- Alfuzocin, Tamsulosin, Finasteride, Dutasteride, Solifenacin, Fesoterodine, Oxybutinin- Immediate Release (IR), Oxybutininin Extended Release (ER), Mirabegron, andTadalafil.

Results

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Of the 210 respondents, most were from the UK (65%). 92% were Urologists or Urology trainees.

Tamsulosin was the most preferred prescription with 96% being ‘Extremely likely’ to prescribe it, whereas nearly half were ‘Extremely unlikely’ to offer Oxybutynin-immediate release. Next most preferred (for patients) was Finasteride. Interestingly Alfuzocin which is reported to have an overall better safety profile than tamsulosin remained a significantly less preferred prescribing choice than the latter. Furthermore, practitioners preferred taking Tamsulosin over Alfuzosin despite both being deemed similarly effective (mean rating 6.9).

Overall, Solifenacin was deemed the most effective medication for male LUTS, and Oxybutinin IR, thought to be the least effective.

Most practitioners would not take 5-alpha-reductase inhibitors, and Finasteride was a favoured prescription choice (64% rating >/= 7) over dutasteride (54% rating </= 4) despite similar perceptions of efficacy.

Daily Tadalafil was an ‘Unlikely’ prescription (48% rating </= 4), however, many practitioners would be ‘Very Likely’ to take it (43% rating >/= 7).

Similar patterns were noted in the patient prescription and self prescription patterns with some of the antispasmodics, though Mirabegron tended to be a favored choice in both instances over Solifenacin; 65% and 62% of clinicians would take Mirabegron and Solifenacin respectively if they were apporpriate patients, while 62% and 61% would prescribe Mirabegron and Solifenacin respectively. Solifenacin remained the favorite for self prescription among antimuscarinincs. Percentages were compared with the weighted averages in each instance.

Conclusion

The prescribing choices of Urologists for male LUTS management do not necessarily mirror their personal preferences. The results obtained from this study can drive future studies on the actual factors which dictate prescribing choices in various climes- side effect profile, cost and payment methods, demographics, prevalent local prescriptions and more.

Furthermore, more robust studies may provide much needed information which could drive development of future medication and prescribing climates that enhance desireable characteristics and minimize unfavorable ones.

Funding

None (Self funded)

Co-Authors

Francesca Kum, FRCS
King's College Hospital London

Gordon Muir, FRCS
King's College Hospital London