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Real-world data and treatment patterns of patients with lower urinary tract symptoms due to benign prostatic hyperplasia in Germany: an observational study using health insurance claims data

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Benign prostatic hyperplasia (BPH) is associated with lower urinary tract symptoms (LUTS), representing one of the most common urological conditions. However, insights into the actual healthcare of this patient cohort in Germany are scarce. We aimed to retrospectively analyse management patterns of patients with LUTS in Germany using health insurance claims databases.


A retrospective, longitudinal cohort analysis was conducted obtaining claims data from the German InGef health insurance database containing approximately five million member-records from over 60 nationwide statutory health insurances. First, a cross-sectional prevalence analysis was performed on all individuals with a diagnosis on LUTS (ICD-10 GM N40) in 2018. Second, a longitudinal analysis of individuals with either a newly started BPH medication or initial BPH surgery who were indexed in 2014 and followed-up for 4 years.


In 2018, 132,386 (6.7%) prevalent BPH patients were identified from 1,979,916 continuously insured males. A potential overcoding bias could not be assessed which may influence the outpatient sector estimation. 10,361 (0.7%) patients were identified with incident BPH medication and 1768 (0.1%) patients with incident BPH surgery out of 1,575,604 males (2013–2018). Alpha-blockers were the drug of choice (95.6%) in the first year. Half of patients received specific BPH medications four years after index, while almost 98% of initial BPH surgeries were performed within the inpatient setting. TURP was the most frequent surgical intervention (76%).


A widespread diffusion of alternative individualized minimally invasive approaches in the outpatient sector might address pharmacotherapy discontinuation and patient-access barriers to other treatments.

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Authors and Affiliations



AM: protocol/project development; data analysis, manuscript writing/editing; JF: data analysis, manuscript writing/editing; BL: protocol/project development; data analysis, data collection or management, manuscript writing/editing; IK: data analysis, manuscript writing/editing; VM: data analysis, manuscript writing/editing; DM: data collection or management, data analysis, manuscript writing/editing; MM: protocol/project development; data collection or management, data analysis; CG: protocol/project development; data analysis; RS: protocol/project development; data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Berit Libutzki.

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Conflict of interest

Prof. Dr. med. Christian Gratzke is advisor for Astellas Pharma GmbH, DE, Ipsen Pharma GmbH, DE, Steba Biotech S.A., LUX, Bayer Pharma, DE, Olympus Winter & Ibe GmbH, DE, Medi-Tate Ltd., IL, MSD, DE, Astra-Zeneca, UK and Roche, CH. He receives speaker fees from Amgen, USA, Astellas Pharma GmbH, DE, Ipsen Pharma GmbH, DE, Janssen-Cilag GmbH, BEL, Bayer Pharma, DE, Takeda Pharmaceuticals, JPN and medac GmbH, DE. Prof. Dr. med. Arkadiusz Miernik has received research funding from the Federal Ministry of Education and Research (BMBF), DE, coverage of travel expenses from the German Association of Urology (DGU), DE, European Association of Urology (EAU), NL; he is advisor for KLS Martin GmbH, DE, Dornier MedTech Europe GmbH, RichardWolf GmbH, DE, KarlStorz SE & Co. KG, DE, Lisa laser OHG, DE, Boston Scientific, USA, Dornier MedTech Europe GmbH, DE, Medi-Tate Ltd., IL and reviewer for Ludwig Boltzmann Gesellschaft, A; he has royalties from Walter de Gruyter, DE, Springer Science + Business Media, DE. Dr. med. Jonas Fritzsche has no conflict of interest to declare. At the time to conduction of this study Berit Libutzki, Melanie May and Damon Mohebbi were employees of HGC Healthcare Consultants GmbH, which received funding from Medi-Tate Ltd. to conduct this study. Vanessa Malka and Ido Kilemnik are employed at Medi-Tate Ltd. Dr. med. Rodrigo Suarez has no conflicts of interests to declare.

Human participants and/or animals

This analysis is based on retrospective claims data of individuals insured within the German statutory health insurance. All individual patient data were de-identified to comply with German federal data protection regulations. Due to data protection regulations, patient numbers below five were not displayed.

Informed consent

The analysis did not involve decisions regarding interventions or the omission of interventions, therefore, institutional review board/ethical approval and patient informed consent was not needed.

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Miernik, A., Fritzsche, J., Libutzki, B. et al. Real-world data and treatment patterns of patients with lower urinary tract symptoms due to benign prostatic hyperplasia in Germany: an observational study using health insurance claims data. World J Urol 39, 4381–4388 (2021).

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