Do urologists apply benign prostatic hyperplasia clinical practice guidelines? Survey on the complementary investigation request modalities in France.

Introduction : In an attempt to standardize clinical practice, a number of authorities (American, European, international) have published guidelines for the assessment and treatment of men with lower urinary tract symptoms (LUTS) related to BPH. In order to determine the impact of these guidelines on daily practice, we conducted a survey of the initial management of BPH by French Urologists. Methods : A clear and simple clinical situation was defined and sent to the 796 urologists members of the Association Francaise d'Urologie: a 65-year-old man presenting with moderate and bothersome lower urinary tract symptoms (LUTS) suggestive of BPH. Various items concerning the choice of complementary investigations were proposed. The last question evaluated the first-line drug prescription. The replies were then analysed as a function of the type of practice and the urologist's age. Results : 184 urologists answered the questionnaire. The mean age of the responding urologists was 47.5 years. 31.6% of responses were derived from hospital urologists, 52.2 % from private urologists and 16.2% from urologists with a mixed practice, which corresponds to the distribution of urology practices in France. Assessment of BPH comph. sed clinical interview and digital rectal examination for all urologists, IPSS score for 23.3%, serum creatinine for 44.7%, dipstick urinalysis and/or urine culture for 72.7%, PSA assay for 98%, uroflowmetry for 65%, renal ultrasound for 80.8%, bladder ultrasound for 84.5%, suprapubic prostatic ultrasound for 61.8%, transrectal ultrasound for 54.2 %, post-voiding residue for 89.9%, fibroscopy for 4.7% and 59.6% a urologists would have instituted medical treatment by this first visit. The initial assessment was similar regardless of the type of practice or the urologist age (greater than or less than 45 years). Hospital urologists and urologists in mixed practice performed statistically more IPSS scores, uroflowmetry or fibroscopy and fewer bladder or renal ultrasound examinations. Conclusion : The management of BPH in France is globally similar among urologists regardless of their age or type of practice and does not correspond to current international and national guidelines. These guidelines, designed to limit the number of examinations in countries with ageing populations who are particularly affected by lower urinary tract symptoms, must be more widely diffused. However this diffiision is not sufficient to ensure acceptance and application of these guidelines. It is therefore essential to conduct real practice surveys among practitioners to evaluate these guidelines, demonstrate differences and try to understand these differences.