Objective To analyse the level of agreement amongResults For the 18 patients, the urologists, as a first choice, treated a mean (sd, range) of 8.3 (3.4, 3-16) urologists from the industrialized world in the management of men with lower urinary tract symptoms patients with TURP, 3.9 (3.6, 0-11) with alphablockers, 2.3 (1.7, 0-6) with watchful waiting and (LUTS). Methods Thirty-three urological departments partici-1.7 (2.4, 0-9) with finasteride. The other therapy options were only oÂered as a first choice by a few of pated in the study. A computer program was used to provide an unbiased format of 18 simulated the urologists in a few of the cases. The mean (sd, range) cost per patient of the diagnostic process was cases of men with LUTS which individual urologists then evaluated diagnostically and made therapeutic US$ 594 (209, 326-1350). Conclusion There was considerable disagreement among decisions about their management. The management of the patients was assessed for the probability that a the urologists about the management of men with LUTS, which included both the choice of diagnostic diagnostic test was used, that a therapy was oÂered to a particular patient, the first-choice therapies selectests and the criteria for oÂering therapy to patients. If such disagreement prevails generally, it may be ted, the mean cost and range for the diagnostic process per patient and the number of first-choice therapies detrimental for the outcome of patients seeking medical attention for LUTS, and the cost of the medical oÂered by one urologist for all the patients. Various discriminators for these therapeutic decisions were care of these patients will be unnecessarily high. Keywords Lower urinary tract symptoms, decision evaluated, analysing the correlations between the information provided by the diagnostic tests and the making, expert consensus, outcome probability of a particular therapy.weakly, which may reflect the considerable disagreement

No abstract

Objective To assess the level of agreement among rancance levels of the generalized kappa statistic, K G , were also calculated. The correlation between the domly selected international urologists on the diagnostic management of patients with prostate cancer, RMA(case) and the diagnostic groups was analysed. Results The K G was statistically significant for all cases; bladder cancer, urinary stones or lower urinary tract symptoms (LUTS) arising from benign prostatic hyperthe RMA(case) was significantly correlated with the diagnostic groups (rs=0.86). The agreement in the plasia (BPH). Methods A computer program was used to provide an diagnostic management was the strongest for stones, then for bladder cancer and prostate cancer, and the unbiased format of 53 simulated patients, comprising 13 with prostate cancer, 10 with bladder cancer, 10 weakest for BPH. The mean cost for the diagnostic evaluation for one case varied from $455 to $1771 with stones in the upper urinary tract and 20 with LUTS from BPH. For each case, the history was (mean 898) and varied in the diagnostic groups, i.e. $1718 for prostate cancer, $947 for bladder cancer, provided to the user while information from 60 diagnostic tests could be chosen interactively. Thirty-three $400 for stones and $594 for BPH. Conclusion The diagnostic management of urological university-based urologists participated in the study. The probability that a certain test was used by them patients varies greatly among urological experts from the industrial world. As a consequence, the related in a certain patient [P(test)] and the related costs (Swedish 1995 prices) were recorded. The probability diagnostic costs might vary by about 400% if prices were similar everywhere. The agreement on the diagthat two urologists would agree (relative measure of agreement, RMA) on whether or not to use one nostic management of cases is strongly correlated to the diagnosis. LUTS from BPH seems to be managed particular test in a certain case was RMA(test)= P(test)2+[1-P(test)]2 and the mean of this RMA(test) with the poorest agreement.

A questionnaire concerning micturition symptoms and bother was answered by 2559 (66%) randomly selected males. Voiding problems increased with age from about 4 to 40%. The symptoms were weakly but significantly correlated to each other (rs < 0.55). The ability of a particular symptom question to predict whether a subject actually would seek a doctor was generally low. A score system with a maximum score of 33 points was constructed. If prostatism was defined as a certain score or higher, a change in the definition in the score interval 4-10 would change the number of subjects with this syndrome with approximately 10%/score point. As a consequence of the results, the use of a symptom score as a criterion for the decision to treat patients suffering from prostatism is challenged. A patient administered symptom evaluation from is strongly recommended to obtain a more objective symptom registration.

In order to estimate the probabilities that a patient would belong to subgroups created by the diagnostic tests most used by European urologists four hundred and twenty-one consecutively referred prostatism patients were studied. It was demonstrated that all the qualities described by these tests were distributed in such a way that the presumed accuracy of the tests might result in a 20 per cent variance in the number of treated patients. A simple self administered home flow test, which was significantly correlated to the maximum flow rate, was shown to be stronger correlated to the symptoms of the patients compared to any other quality. A stochastic table for prostatism was constructed, which may be used for estimations of the influence different decision making may have on the outcome of treatments in this kind of patients.