• Consider the importance of the urological function to our health and well-being
• Examine the common urological conditions in the population
• Assess the role that real world data can play in improving our understanding of urology disease and patient outcomes, and also consider broader benefits this could bring such as slowing antimicrobial resistance, “an increasingly serious threat to global public health that requires action across all government sectors and society”

The importance of the urology function to our health and wellbeing

Urology health relates to the parts of the body responsible for producing, storing and discharging urine. These include kidneys, bladder and urethra, and in men, the parts of our bodies involved in sexual function, which are the prostrate, penis and testicles. Urology impacts men and women in all stages of life from infancy to old age. Health problems in these body parts can happen to anyone and are incredible common; it is estimated that 1 in 2 of us will be affected by a urological condition at some point in our lifetime.

What is urological disease?

The term urological diseases describes a wide variety of conditions all related to the filtering and carrying of urine out of the body. They include some of the most common diseases in the UK such as prostate cancer, kidney damage, and incontinence. Other diseases include bladder and testicular cancers, kidney stones, interstitial cystitis and urinary tract infections. Although many of these conditions are not immediately life threatening, they have a major impact on the quality of everyday life. In this blog we look at the most common of these, infections of the urinary tract.

A urinary tract infection (UTI) is when bacteria gets into your urine and travels up to your bladder. 50% of women in the UK will develop a UTI at least once. When you have a UTI, the lining of the bladder and urethra become red and irritated which can cause pain in your abdomen pelvic and lower back. Other symptoms include a constant feeling of needing to urinate, burning or pain when urinating, and loss of bladder control causing urine leakage and generally feeling tired and unwell. In older people, UTIs can cause changes in behaviour such as severe confusion or agitation, and can be difficult to spot in people with dementia.

Women are more likely to get a UTI than men. Shorter urethras in women mean bacteria around the rectum and vagina that cause infection, have a shorter distance to travel to reach the bladder. Other factors that contribute to higher infection rates include the menopause, abnormally shaped bladders, and other illnesses such as diabetes. Use of urinary catheters, flexible tube used to empty the bladder in people with bladder problems, increases the risk of UTIs. The incidence of UTI rises in older adults, increasing substantially for both men and women over the age of 85 years.

UTIs are diagnosed by analysing a urine sample for bacteria or white blood cells, which are signs of infections. There are two types of UTI: simple and complicated. Simple UTIs are infections that happen in healthy people with normal urinary tracts, complicated UTIs happen in abnormal urinary tracts or when bacteria causing the infection cannot be treated by many antibiotics.

Management and treatment of urinary tract infections…is there room for improvement?

In the UK, primary healthcare settings are usually the first line in dealing with the newly emerging symptoms of urological conditions, with the vast majority of these treated by GPs. Real world data can help us understand how well we are identifying, diagnosing and treating patients with UTIs. It can also help us assess how well treatments are working, and highlight areas for potential improvement.

Antibiotics are usually the first line treatment of urinary tract infections. The chosen drug, and duration of treatment depends on the severity of symptoms and the type of bacteria causing the infection. Shorter 3 day course antibiotic treatments are the recommendation for uncomplicated UTIs, with longer courses for more complicated cases. There is increasing evidence that hospital admission for UTI is increasing the UK, and emergency admissions due to UTIs have almost doubled since 2013, mainly due to recurrent UTIs.

Leveraging the UK’s unique health data ecosystem to support urology treatment

Real world data can be used to conduct population-based studies in a representative “real world” population. IQVIA Medical Research Data (IMRD) incorporating data from THIN, a Cegedim Database, includes non-identified electronic patient health record data from over 18 million patients collected from UK GP Practices using Vision clinical systems. IQVIA implement a wide variety of privacy-enhancing technologies and safeguards to protect individual privacy while maximising the utility of the data for medical research and treatment analysis. IQVIA Medical Research Data captures coded demographic, administrative data, clinical events, prescriptions, with secondary care and death information. IQVIA Medical Research Data covers approximately 4.5% of the UK population and provides a valuable source of nationally representative and generalisable data that can be used for robust scientific retrospective cohort studies.

What has real world data told us about urology care in the UK?

In 2015, a study was conducted using IMRD real world data examining the pharmacological management of men who have lower urinary tract symptoms associated with benign hyperplasia (BHP), enlargement of the prostate. The study aimed to evaluate treatment patterns of men diagnosed with BHP and UTI in UK primary healthcare settings. The researchers concluded that a high proportion of men are sub-optimally treated in routine clinical practice evidenced by the lack of the recommended concomitant beta-blocker being prescribed.

In 2018, a study using IMRD looked to define appropriate and inappropriate prescribing of antibiotics in primary care. In the case of UTIs, the researchers recommended that only one third of non-pregnant women presenting with symptoms of non-recurrent UTI, required antibiotics to be prescribed. However, a retrospective observational study conducted in April 2019 using the clinical practice research datalink (CPRD), observed that 72.1% of women presenting with UTI symptoms were prescribed anti-biotics.

A recently published study (April 2020) of females diagnosed with uncomplicated UTIs attending accident and emergency, found that over treatment of UTIs with antibiotics is common practice, as is excessive prescribing of long course antibiotics.

Antibiotics are essential medicines for the treatment and prevention of bacterial infections, but their efficacy is increasingly threatened by the emergence of antimicrobial resistance (AMR). In UTIs more needs to be done to understand when it is appropriate to prescribe antibiotics and what effect this has on patient outcomes. One way of doing this is to see what happens in a real world setting and to communicate the findings to healthcare professionals through new research.

For more information on IQVIA Medical Research Data please contact james.philpott@iqvia.com