Yonsei Med J.  2007 Apr;48(2):281-288. 10.3349/ymj.2007.48.2.281.

Patterns in the Diagnosis and Management of Benign Prostatic Hyperplasia in a Country that does not have Country-Specific Clinical Practice Guidelines

• Paick JS
• Kim SW
• Ku JH

• KMID: 1779532
• DOI: http://doi.org/10.3349/ymj.2007.48.2.281

Abstract

PURPOSE
We have evaluated the patterns of diagnostic and treatment practices for benign prostatic hyperplasia (BPH) in a country that does not have country-specific clinical practice guidelines. MATERIALS AND METHODS: Probability samples were taken from the Korean Urological Association Registry of Physicians, and randomly sampled Korean urologists were asked to complete a questionnaire. The survey explored practice characteristics and attitudes, as well as diagnostic and treatment strategies, for the management of BPH. RESULTS: Of the 850 questionnaires sent, 302 were returned, and 277 of those were included in the final analysis (response rate 32.6%). For the initial evaluation, most urologists routinely used digital rectal examinations (DRE) and urinalysis. Uroflowmetry was used 34.7% of the time. Pressure-flow studies were rarely done. Symptom assessment was used in only 46.9% of cases. In addition, a significant number (58.8%) reported that treatment decisions were not based on the symptom questionnaire. Before surgery, almost all urologists routinely used DRE, urinalysis, and prostate-specific antigen tests. Of the respondents, 55.6% and 41.9% had prescribed alpha- blockers and alpha-blockers with 5-alpha reductase inhibitors, respectively. 81.2% of urologists perceived that selective alpha-blockers are different in terms of efficacy, and 82.7% felt that they differed in safety. Most respondents prescribed 5-alpha reductase inhibitors based on the prostate size. CONCLUSION: These data provide a picture of current practices regarding the management of BPH in Korea. The diagnostic and treatment practices for BPH do not follow published guidelines. Our findings ask the question "How influential are international guidelines, and do they really affect patient management in countries that do not have country-specific guidelines?"

Keyword

Prostate; practice patterns; benign prostatic hyperplasia; prostatic neoplasms

MeSH Terms

Urology/standards
Societies, Medical
Questionnaires
Prostatic Hyperplasia/diagnosis/*therapy
Practice Guidelines
Middle Aged
Male
Korea
Humans
Diagnosis, Differential
Developing Countries
Aged
Adult

Reference

1. Guess HA, Arrighi HM, Metter EJ, Fozard JL. Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate. 1990. 17:241–246.

2. Chute CG, Panser LA, Girman CJ, Oesterling JE, Guess HA, Jacobsen SJ, et al. The prevalence of prostatism: a population-based survey of urinary symptoms. J Urol. 1993. 15:85–89.

3. McConnell J, Barry M, Bruskewitz R, Bueschen AJ, Denton SE, Holtgrewe HL. Benign prostatic hyperplasia: Diagnosis and treatment, Clinical Practice Guideline No. 8, AHCPR Publication No. 94-0582. 1994. February. Rockville, Maryland: Agency for Healthcare Policy and Research, Public Health Service, U.S. Department of Health and Human Services.

4. Roerhborn CG. The Agency for Healthcare Care Policy and Research. Clinical guidelines for the diagnosis and treatment of benign prostatic hyperplasia. Urol Clin North Am. 1995. 22:445–453.

5. RCS/BAUS. Guidelines on the management of men with lower urinary tract symptoms suggestive of bladder outlet obstruction. 1997. London: Royal College of Surgeons, in association with the British Association of Urological Surgeons.

6. de la Rosette JJ, Alivizatos G, Madersbacher S, Perachino M, Thomas D, Desgrandchamps F, et al. EAU Guidelines on benign prostatic hyperplasia (BPH). Eur Urol. 2001. 40:256–264.

7. Roehrborn CG, Bartsch G, Kirby R, Andriole G, Boyle P, de la Rosette J, et al. Guidelines for the diagnosis and treatment of benign prostatic hyperplasia: a comparative, international overview. Urology. 2001. 58:642–650.

8. Chatelain C, Denis L, Foo KT, Khoury S, McConnell J. Recommendations on the International Scientific Committee. Benign Prostatic Hyperplasia. 2001. Plymouth, United Kingdom: Health Publication Ltd..

9. AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol. 2003. 170:530–547.

10. Irani J, Brown CT, van der Meulen J, Emberton M. A review of guidelines on benign prostatic hyperplasia and lower urinary tract symptoms: are all guidelines the same? BJU Int. 2003. 92:937–942.

11. Berges R, Dreikorn K, Hofner K, Jonas U, Laval KU, Mardersbacher S, et al. Guidelines for German urologists on diagnosis of benign prostate syndrome. Urologe A. 2003. 42:584–590.

12. Berges R, Dreikorn K, Hofner K, Jonas U, Laval KU, Mardersbacher S, et al. Guidelines of German urologists on therapy of benign prostate syndrome. Urologe A. 2003. 42:722–738.

13. Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol. 2004. 46:547–554.

14. Nickel JC, Herschorn S, Corcos J, Donnelly B, Drover D, Elhilali M, et al. Canadian guidelines for the management of benign prostatic hyperplasia. Can J Urol. 2005. 12:2677–2683.

15. Burnett AL, Wein AJ. Benign prostatic hyperplasia in primary care: what you need to know. J Urol. 2006. 175:S19–S24.

16. McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW, et al. Medical Therapy of Prostatic Symptoms (MTOPS) Research Group. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003. 349:2387–2398.

17. Roberts RO, Jacobsen SJ, Jacobson DJ, Rhodes T, Girman CJ, Lieber MM. Longitudinal changes in peak urinary flow rates in a community based cohort. J Urol. 2000. 163:107–113.

18. Rhodes T, Girman CJ, Jacobsen SJ, Roberts RO, Guess HA, Lieber MM. Longitudinal prostate growth rates during 5 years in randomly selected community men 40 to 79 years old. J Urol. 1999. 161:1174–1179.

19. Roehrborn CG, McConnell J, Bonilla J, Rosenblatt S, Hudson PB, Malek GH, et al. Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term efficacy and safety study. J Urol. 2000. 163:13–20.

20. Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol. 1997. 158:481–487.

21. Nickel JC, Saad F. The American Urological Association 2003 guideline on management of benign prostatic hyperplasia: a Canadian opinion. Can J Urol. 2004. 11:2186–2193.