The AUA Quality Registry (AQUA) was developed in 2014 by the AUA to help urologists with Merit-Based Incentive Payment System reporting. The AQUA Registry is a national Qualified Clinical Data Registry (QCDR) designed to measure, report, and improve health care quality. The AQUA Registry collects real-world data directly from the participants’ electronic health record system. This automated process allows practices to participate in quality improvement activities, contribute to national urology benchmarks, and have access to urology-specific quality measures. This year we celebrate 10 years of the AQUA Registry.

Currently there are 215 urology practices who participate in AQUA with 2350 active urology providers. AQUA-participating practices are in 41 states. Since 2014, the registry has grown from 1.18 million patients to 12.1 million patients in 2023. The total number of patient encounters in 2014 was 6.17 million but now exceeds 96 million patient encounters over 10 years. In 2020, the AUA entered into a collaboration with Verana Health to build new analytical applications and user interfaces to enhance the quality of the registry data.

The AQUA Registry has been used by the AUA to build 5 major patient cohort datasets to date including: overactive bladder, benign prostatic hyperplasia, kidney and ureter stones, male stress urinary incontinence, and erectile dysfunction. Additionally, Verana Health has 2 patient cohort datasets: prostate cancer and nonmuscle-invasive bladder cancer. These datasets are making AQUA Registry data more accessible to researchers, which will allow us to better understand practice patterns and improve quality of care in urology. Twelve peer-reviewed publications based on AQUA data have been published to date and the AUA Data Research Program provides researchers with support and access to the AQUA data to address clinical research questions.

So, what have we learned from the AQUA Registry? Diseases of the prostate dominate urologic practice. The 4 top International Classification of Diseases codes in AQUA are all prostate-related with the top-2 codes related to benign prostatic hyperplasia followed by elevated PSA and malignant neoplasm of the prostate. In fact, 7 of the top 20 diagnostic codes are related to prostate disease and account for nearly 53 million encounters. Erectile dysfunction, stone disease, urinary symptoms, and medical comorbidities such as diabetes mellitus and hypertension account for most of the rest of the top 20.

Not surprisingly, the 2 most-common current procedural terminology codes were related to outpatient office visits: 99214 and 99213. Urinalysis codes (81000-81003) were billed 44 million times and measurement of postvoid residual (51798) was billed 17 million times. Over 6 million cystoscopies were performed in an outpatient office. The most-common blood test performed was PSA with almost 7 million samples.

In keeping with the idea that prostate disease is still the most-common diagnosis, tamsulosin (Flomax) is the most-common medication prescribed with over 5 million prescriptions written. Finasteride is the third most-common medication with 1.1 million prescriptions. Cipro follows tamsulosin as the second most-commonly prescribed medication and is the most-common antibiotic prescribed, followed by Bactrim DS and Macrobid. Myrbetriq is the most-frequently prescribed bladder medication and sildenafil the most-frequent erectile dysfunction medication. AQUA providers wrote a surprisingly high number of prescriptions for comorbidities including amlodipine, omeprazole, pantoprazole, fluticasone propionate nasal spray, atorvastatin, and aspirin. Tramadol and hydrocodone/acetaminophen were the 2 most-frequently prescribed pain medications.

As we celebrate the 10th anniversary of the AQUA Registry, more and more pertinent data is available for research and quality improvement. In collaboration with Verana Health, the AUA is better able to access and utilize data from the AQUA Registry. Although AQUA was created to provide a data source for Merit-Based Incentive Payment System reporting, AQUA data is becoming transformative in understanding the real-world practice of urology.