AUTHOR=Morgia Giuseppe , Lo Giudice Arturo , Asmundo Maria Giovanna , Rapallo Ilenia , Carrino Maurizio , Persico Francesco , Terrone Carlo , Malinaric Rafaela , Tedde Alessandro , Madonia Massimo , Voce Salvatore , Reale Giulio , Larganà Gaetano , Cocci Andrea , Masieri Lorenzo , Zingone Francesca , Carcò Daniela , Russo Giorgio Ivan 

TITLE=Adherence to Urological Therapies for Lower Urinary Tract Symptoms Due to Benign Prostatic Enlargement During COVID-19 Lockdown

JOURNAL=Frontiers in Urology

VOLUME=Volume 2 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/urology/articles/10.3389/fruro.2022.925575

DOI=10.3389/fruro.2022.925575

ISSN=2673-9828

ABSTRACT=Background: Due to the pandemic emergency secondary to COVID-19, many countries were forced to apply a variety of measures such as quarantine and total-nation-lockdown in order to contain the contagion. Medical adherence to chronic diseases may have been negatively influenced by restrictions due to COVID-19 pandemic. The purpose of this study is to investigate lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPE) patients’ adherence to urological therapies during COVID 19-lockdown period. 
Methods: In this cohort study we included a total of 151 male patients who had been prescribed medication for LUTS/BPE between January 2019 and December 2020. The prescriptive data of the following drugs were collected: alpha-blockers (AB), 5-alpha reductase inhibitors (5-ARI), 5-phosphodiesterase inhibitors (PDE5-i), anti-muscarinic, phytotherapy (i.e. serenoa repens). According to adherence or discontinuation of therapy, patients have been divided into two group; those who took their medication for a minimum of six months during the index period were considered into “Medical adherence group”; otherwise, the treatment was considered as “discontinued” if it was interrupted for a one-month period. 
Results: Overall, median age was 69.0 (interquartile range [IQR]: 63.0-74.0), median IPSS before lockdown was 15.0 (IQR: 11.0-18.0) and median IPSS-QoL before lockdown was 2.0 (IQR: 2.0-3.0). During lockdown, 19 patients (12.58%) stopped assumption of drugs due to pandemic situation and in particular, six (31.58%) stopped phytotherapy, two stopped AB + phytotherapy (10.53%), five stopped AB (26.32%), three stopped 5ARI (15.79%), one stopped antimuscarinic (5.26%) and two stopped other combination therapy (p<0.01). Among patients who stopped therapy, five (26.31%) reported a worsening of symptoms (score ≥ 3) while 14 (73.69%) did not (score < 3). During lockdown, five (3.31%) patients required hospitalization and in particular three (1.99%) for acute urinary retention and two (1.32%) for urinary tract infection. 
Conclusions: 	The rate of medical adherence for LUTS/BPE during COVID19 was 86.75% but 13.25% of patients interrupted drugs due to the pandemic situation. This rate has determined a slight increase of symptoms with potential impact on hospitalization. These results should be taken into account in order to build-up adequate strategies in telehealth to maintain medical adherence for chronic diseases.