BackgroundTo investigate the relationship between age, prostate specific antigen (PSA), and prostate volume (PV) in Indonesian men with histologically proven benign prostatic hyperplasia.MethodsData were generated from our BPH database from June 1994 until December 2013. Subjects were men with a minimum age of 40 years with chief complaint of LUTS or urinary retention, diagnosed with BPH. All patients underwent TRUS-guided prostate biopsy. Patients with PSA level >10 ng/mL were excluded from the study to exclude the possibility of occult prostate cancer. PV was measured with TRUS. Appropriate statistical tests were employed for data analysis.ResultsIn all, 1638 patients were enrolled in our study. There was a statistically significant difference in PSA (P = 0.03) and PV (P < 0.0001) between age groups. Overall correlation between age, PSA, and PV were: i). Age and PV (r = 0.12, P < 0.0001); ii). Age and PSA (r = 0.07, P = 0.008); iii). PSA and PV (r = 0.26, P < 0.0001). Subgroup analysis in terms of indwelling catheter use versus without: i). Age 66.09 ± 8 years versus 65.38 ± 7.66 years (P = 0.158); ii). PSA 4.93 ± 2.62 ng/mL versus 4.68 ± 2.82 ng/mL (P = 0.038); iii). PV 47.58 ± 21.33 mL versus 41.43 ± 20.55 mL (P < 0.0001). Correlation between age, PSA, and PV in patients were similar in patients with and without indwelling catheter.ConclusionIn Indonesian men with biopsy-proven BPH, both PV and PSA increased with ageing. Prostate volume was significantly correlated with PSA. Even though the results were weaker, these results are consistent with results in other sets of population. The results vary between different countries and thus, ethnicities. Indonesia is a populous a sociocultural and ethnically diverse country. Therefore, aside from PSA, age, and PV, when investigating men with BPH, ethnicity may also need to be taken into account.

Background The complexity of International Prostate Symptom Score (IPSS) as an objective questionnaire for lower urinary tract symptoms might be overcome with alternative questionnaire such as the Visual Prostate Symptom Score (VPSS) which uses pictograms instead of questions to illustrate some of the questions addressed in IPSS. Methods Male patients older than 45 years with lower urinary tract symptoms were evaluated with Indonesian version of the IPSS and VPSS, for uroflowmetry parameters using a transabdominal ultrasound. Appropriate statistical analysis was used. Results Of all participants, 24.2% and 11.1% require assistance when answering IPSS and VPSS questionnaires, respectively. The mean age, IPSS total score, VPSS total score, Qmax, voided volume, and postvoid residual volume were 67.4 ± 8.9 years, 13.4 ± 7.8, 10.8 ± 2.7, 13.6 ± 8.6 mL/sec, 248 ± 136 mL, and 54.9 ± 68.3 mL, respectively. Total IPSS, IPSS quality of life (QoL), IPSS question (Q) 2, IPSS Q7, and IPSS Q5 were significantly correlated with total VPSS, VPSS QoL, VPSS Q1, VPSS Q2, and VPSS Q3 [correlation coefficient (r) P value: 0.57, <0.001; 0.76, <0.001; 0.39, <0.001; 0.72, <0.001; 0.50, <0.001, respectively]. VPSS Q3 was significantly correlated with Qmax (r, P value: −0.26, <0.001). There was a significant relationship between the level of education and the ability to complete IPSS questionnaire ( P < 0.001). There was no significant relationship between the level of education and the ability to complete VPSS questionnaire ( P = 0.649). Conclusion The VPSS was significantly correlated with IPSS and Qmax. The novel questionnaire proved useful as an alternative tool for IPSS for assessing men with lower urinary tract symptoms, especially for those with lower level of education.

BackgroundClinical guideline is built to provide consistent, efficient, and high quality of medical care based on recent evidence. This study aimed to investigate the adherence of Indonesian urologists to clinical guidelines for the management of benign prostatic hyperplasia (BPH).Materials and methodsThis was a cross-sectional study using questionnaire conducted between January and June 2017. Respondents were Indonesian urologists registered as members of Indonesia Urological Association and had already practice in urology for at least 6 months. Questionnaires were sent via e-mail and Google Form. The level of adherence was measured using scoring system decided by authors' agreement. All data were processed using SPSS, version 23, and presented in descriptive fashion.ResultsOf 352 urologists who fulfilled inclusion and exclusion criteria, 209 (59.4%) respondents returned the questionnaire. Most of respondents (95.2%) used Indonesia Urological Association BPH guidelines as their clinical practice guidance. Routinely performed recommended examination, such as symptom scoring system, digital rectal examination, urinalysis, uroflowmetry, postvoid residual urine, and prostate imaging were used by 89.9%, 92.5%, 70.4%, 50.8%, 53.3%, and 98.6% respondents, respectively. After patient is diagnosed with BPH, most of respondents considered medical therapy (99%), surgical therapy (93%), and watchful waiting (78.4), with alpha-blocker as the drugs most preferred by respondents. For indication to perform surgery for BPH, only bladder stones, decreased renal function, and trial without catheter failure were considered by more than 85% of respondents. Open prostate surgery was performed by 54.8% respondents for the following reasons: large prostate volume, presence of bladder stone, unavailability of endourology equipments, abnormality of bladder, and residency training program. At last, this study found median (minimum–maximum) of Indonesian urologists adherence level toward BPH guidelines is 78.5% (28.6%–100%).ConclusionsIn general, Indonesian urologists have a good adherence toward guidelines. However, there is still wide variation of their adherence to it.