Cross-Sectional Study On Diagnosis, Treatment And Health Care Wishes For Geriatric Outpatients With Benign Prostatic Hyperplasia In Chinese Cities

Objectives:To identify the proportion, objective parameters, the lower urinary tract symptoms (LUTS) and quality of life(QOL) of benign prostatic hyperplasia (BPH) in geriatric outpatients in China, and determine the personal risk factors correlated with LUTS.Materials and methods:A stratified random sampling was used.The primary sampling units were cities:11 cities in north (Lanzhong, Beijing, Shenyang and Jinan) and south China (Chendu, Guangzhou, Changsha, Wuhan, Hangzhou, Nanjing and Shanghai) were selected. The secondary sampling units were medical centers:3 medical centers were randomly selected in each city, resulting in a total of 33 centers. The final sampling units were subjects, patients selected from the geriatric outpatient department in each medical center during the study period.781 outpatients in north, and 1246 outpatients in south. All case report form data were entered into Epidata3.0. The data bases were frozen until released for statistical analyses (SAS version 9.13, SPSS version 13.0 and Amos version 17.0).Results:47% geriatric male patients visiting outpatient department had BPH. The mean prostate volume and IPSS in the north were higher than those in the south (43.9+19.7 vs.39.5±18.8 and 13.7±7.2 vs.13.0±7.3, respectively), (P<0.001; P=0.037, respectively). Mean age and peak flow rate in the north were lower than those in the south(74.6±6.9 vs. 76.8±6.7 and 9.3±2.7 vs.9.9±2.9, respectively), (P<0.001; P=0.003, respectively). In a multivariate logistic model, the severity of symptoms are higher among patients who are older age, who live in north-west and who are managers.There is relationship between prostate volume, peak flow rate and QOL and IPSS. The significant positive correlations between IPSS and prostate volume (r=0.220, P< 0.001), and QOL (r=0.640, P<0.001). The significant negative correlations between IPSS and peak flow rate (r=-0.236, P<0.001).Conclusions:In our study, approximately one in two of geriatric outpatients aged 60 and over had BPH. Obviously, BPH is a threat of elderly male in China. The severe LUTS maybe associate with age, residence, and job luck of physical activity. So preventing works should be conducted. Look forward to provide a scientific evidence for both doctors and patients with BPH in choosing an effective medical treatment.Objectives:To assess the compliance of geriatric doctors to China's Benign Prostatic Hyperplasia Clinical Practice Guideline, to explore the diagnostic and treatment modalities for geriatric patients with benign prostatic hyperplasia (BPH).Materials and methods:A cross-sectional survey study was carried out in 33 medical centers in 11 different cities in China (4 in the north and 7 in the south).190 geriatric doctors participated in a survey to record their preferences in diagnostic tests and treatment options for 2027 BPH outpatients. Data were entered into Epidata3.0. The data bases were frozen until released for statistical analyses (SPSS version 13.0).Results:The doctor's response rate was 97.4%. Respondents generally used diagnostic tests recommended in China's BPH Clinical Practice Guideline with varying rates. The rate of use for medical history, ultrasonography or urinalysis was above 90.0%, with uroflowmetry at 31.2%. In addition, the rate of use of recommended tests was higher among doctors in the north than those in the south. Combination therapy with a-adrenoceptor (AR) antagonists and 5α-reductase inhibitor was the preferred treatment option for BPH (55.0% in the north; 41.6% in the south), which was increasingly used with worsening lower urinary tract symptoms. Finasteride was the most prescribed medication (48.0%), followed by Terazosin (22.7%). the rate of use for 5a-RI monotherapy in the north (28.2%) was higher than that in the south (22.4%); the rates of use forα-adrenoceptor (AR) antagonist monotherapy and plant monotherapy in the north (8.1% and 5.4%) was lower than those in the south (16.4% and 7.9%). The rate of use for combination therapy withα-AR antagonist and 5α-reductase inhibitor (RI) in the north (55.0%) was higher than that in the south (41.6%), while the rate of use for combination therapy with plant andα-AR antagonist or 5α-RI in the north (3.3%) was lower than that in the south (11.7%). The rate of use for combination therapy withα-AR antagonist and 5a-RI was increasing with the severity of symptoms. Conclusions:This study firstly assessed the preferencesof geriatric doctors in diagnosis and treatment of BPH, which will serve as an important reference for updating and improving the current China's BPH Clinical Practice Guideline.Objectives:To evaluate the patient's health care wishes in communication, diagnosis, treatment and medical counseling of geriatric BPH outpatients in China.Materials and methods:From 11 cities in north (Lanzhong, Beijing, Shenyang and Jinan) and south China (Chendu, Guangzhou, Changsha, Wuhan, Hangzhou, Nanjing and Shanghai), The subjects were selected from outpatient department in 33 medical centers during the study period. Health care wishes were collected from surveying 1267 outpatients aged≥60 years.a questionnaire comprising eight questions was used to evaluate the patient's wishes with regard to communication(2 questions), diagnoses(2 questions), treatment(2 questions) and medical counseling(2 questions). the score for each question ranged from 1 (very unnecessary) to 5 (very necessary), The higher the standard score, the higher the patient's wishes. Database was managed with Epidata3.0 and statistical analyses were performed with SPSS version 13.0 and MLwiN version 3.02.Results:The Cronbach's of the questionnaire is 0.845.We measured the degree of patients'wishes on communication, diagnoses, treatment and medical counseling.47.1% patients think it is very necessary to communication with them before doctors use diagnostic tests.39.8% patients think it is very necessary to communication with them before doctors use treatment.85.0% patients think it is necessary for doctor to use the diagnostic tests.80.1% patients think it is necessary for doctor to use the treatment.41.9% patients think it is very necessary for them to get medical counseling on diagnoses.46.1% patients think it is very necessary for them to get medical counseling on treatment. The multilevel model showed the wishes scores data is similarity in between the north and the south. The communication, diagnoses, treatment wishes scores of patients in north are higher in south. And medical counseling wishes scores of patients in north are lower in south. Severe patients had higher wishes on communication and medical counseling than mild or moderate patients.Conclusions:There is significant differences in the patient's health care wishes between the north and the south. And the patients with more severe lower urinary tract symptoms have more wishes on communication and medical counseling.