The urological management of men with lower urinary tract symptoms, recorded using an interactive computer program

Abstract

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

The effectiveness of a scientific symposium to change urologists’ attitude towards treatment of LUTS/BPH

“…Diagnosis and treatment of LUTS/BPH patients varies significantly worldwide [4][5][6][7][8][9][10][11][12], is independent of the degree of specialization in the subject [5,8], and is considerably influenced by the attending physician's personal and traditional preferences [6,9]. Although this was not an objective of the present study, a similar spread of choices was observed in this particular group of Greek urologists that was indeed independent of age and board certification status.…”

“…Although the European Association of Urology (EAU) has produced guidelines concerning the assessment and treatment of men with BPH, which have been published and updated [1,2], data for the real-life practice concerning the management of this condition are expected to come to light from the ambitious transeuropean research into the use of management policies for LUTS suggestive of BPH in primary healthcare (TRIUMPH) project [3]. Several reports have confirmed differences in the attitude of attending physicians towards the diagnostic tactics and therapeutic strategies for LUTS/BPH [4][5][6][7][8][9][10][11][12] that are independent of the degree of specialization in the subject [5,8], but which are related to the subjectivity of the attending physician and his dependency on traditional preferences [9].…”

Are men with lower urinary tract symptoms at increased risk of prostate cancer? A systematic review and critique of the available evidence

“…There is evidence of variation in the management of men with insidious changes in urinary frequency, flow, dribbling, urgency and hesitancy [1–6]. Given this confusion among GPs and urologists alike, several countries have initiated the development of clinical practice guidelines.…”

Evaluating diagnostic and treatment modalities in the management of benign prostatic hyperplasia in the Veterans Administration population

“…This research question is proposed because a study with international urologists indicated disagreement for management of lower urinary tract symptoms (LUTS) (Hansen & Zdanowski, 1997). The study concluded that this might result in increased medical costs.…”

“…This study encouraged the use of simulated patient method as a basis for assessing the actual performance patterns of practitioners. Another study which utilized simulated patients was done to measure level of agreement among randomly selected international urologists in the management of men with lower urinary tract symptoms (LUTS) (Hansen & Zdanowski, 1997). This study utilized computer simulation to provide unbiased format of simulated cases to individual urologists.…”