The Urologic Diseases in America Annual Data Report project, funded by the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH, has been essential in understanding urologic diseases in the US since 2012.¹ The project meticulously documents and analyzes retrospective data, primarily from claims, related to various urological diseases and disorders. The latest release in 2024 presents key highlights in areas such as benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS), urinary stone disease (USD), urinary incontinence (UI), urologic chronic pelvic pain syndrome (UCPPS), and Fournier’s gangrene (FG).

BPH and Associated LUTS

From 2012 to 2021, the prevalence of BPH/LUTS among men aged 40 to 64 was 5% to 6% annually, while for men aged 65 and older, it was significantly higher, at 29% to 35%. In 2020, among newly diagnosed older men, 94% underwent serum creatinine testing, 69% had a urinalysis, 63% received a PSA test, and 22% had a postvoid residual evaluation within 15 months surrounding their diagnosis.

In 2021, 44% of men aged 40 to 64 and 60% of those aged 65 and older with BPH/LUTS filled a prescription for related medication. Over time, there has been a shift toward minimally invasive surgical therapy (MIST) procedures. Transurethral surgery remains the most common surgical approach, particularly transurethral resection of the prostate. The use of laser prostatectomy has declined, likely due to the increasing popularity of laser enucleation and MIST, especially prostatic urethral lift.

In our study of retreatment rates, we found that 5% of men required retreatment within 2 years of their first surgery. Retreatment rates were higher for MIST procedures (11%) compared with transurethral surgeries (3%).

USD

The prevalence of USD among persons aged 18 to 64 was 1% to 2% annually from 2012 to 2021, rising to 3% to 5% among those aged 65 and older. USD often co-occurs with obesity, hypertension, diabetes, and UTIs. In 2020, 70% of USD patients underwent a CT scan within 15 months surrounding their diagnosis.

Our findings also revealed that 17% of newly diagnosed USD patients had an emergency department visit within a year, with approximately 10% having more than 1 emergency department visit. From 2012 to 2021, opioid prescriptions for USD patients decreased from 71% to 56% among those aged 18 to 64 and from 56% to 40% among those aged 65 and older. The use of extracorporeal shock wave lithotripsy also declined, from 9% to 6% among younger patients and from 5% to 3% among older patients.

UI

UI was prevalent in 6% to 8% of individuals aged 65 and older annually from 2012 to 2021, suggesting underreporting by patients and health care providers. UI often co-occurs with conditions such as hypertension, obesity, diabetes, and UTIs, with these comorbidities being more common in UI patients than in the overall study population.

From 2015 to 2020, urodynamics were used in only 7% of cases among newly diagnosed UI patients. Among patients with urgency UI aged 65 and older with full-time Part D enrollment, antimuscarinics were the most commonly filled prescriptions in 2021 (34%), followed by β-3 adrenergic agonists (17%). While antimuscarinic use declined over time, β-3 adrenergic agonist use increased.

For patients aged 65 and older with urgency UI, neuromodulation and botulinum toxin A were the most common procedures. Neuromodulation use increased slightly from 2.3% to 3.2% between 2012 and 2021, while botulinum toxin A use rose from 0.5% to 2.5% during the same period. For stress UI, sling procedures declined from 4.2% to 2.5% between 2012 and 2015, with a slower decline to 2.0% from 2016 through 2021.

UCPPS

For UCPPS, comprising interstitial cystitis (IC)/bladder pain syndrome (BPS) and chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS, for men only), prevalence ranged from 2 to 4 per 1000 persons aged 18 to 64 and from 6 to 8 per 1000 persons aged 65 and older annually from 2012 to 2021. UCPPS is associated with higher rates of urologic symptoms, chronic back pain, mental health issues, and headaches compared with the overall study population. In 2021, over 50% of older UCPPS patients had LUTS, and more than 35% suffered from chronic back pain.

Erectile dysfunction is notably more common in men aged 65 and older with CP/CPPS, with a rate of 17% in 2021, double that of the overall study population in this age group (8%). This finding aligns with research from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network, which reported that men with UCPPS experience greater levels of sexual dysfunction, including both erectile and ejaculatory dysfunction, compared with healthy individuals and those with other chronic pain conditions.² Opioid prescriptions were common among IC/BPS and CP/CPPS patients, though their use declined from 2012 to 2021. Still, in 2021, approximately 40% of UCPPS patients filled an opioid prescription. Despite a decline, the high rate of opioid use remains concerning.

The use of tricyclic antidepressants, muscle relaxants, and histamine receptor blockers remained stable over the last decade for IC/BPS patients, while the use of pentosan polysulfate sodium decreased. The use of antibiotics for CP/CPPS dropped from 67% in 2012 to 49% in 2021, reflecting a better understanding of the condition. The use of hydrodistension for IC/BPS also declined over time, likely due to limited evidence supporting its effectiveness.

FG

The prevalence of FG ranged from 3 to 7 per 100,000 persons annually from 2012 to 2021, with higher rates observed in patients aged 65 to 69 compared with other age groups above 65. FG often co-occurs with diabetes; in 2021, 66% of older FG patients also had diabetes. In 2021, 13% of FG patients filled a prescription for sodium-glucose cotransporter-2 inhibitors or glucagon-like peptide-1 agonists. Mortality remains high among FG patients, with 70% of those aged 65 and older dying within 5 years of their 2015 diagnosis.

For a deeper dive into these findings and more, the full data report is available on the National Institute of Diabetes and Digestive and Kidney Diseases’ website.¹