Study On The Diagnosis, Treatment And Related Influencing Factors Of Benign Prostatic Hyperplasia In Chinese Urologists

Objectives:To explore the diagnostic and treatment modalities of benign prostatic hyperplasia (BPH) in Chinese urologists, including the cognition of the disease, diagnosis, treatment and follow-up of patients. To analyze the differences between the clinical practices of urologists and China’s Benign Prostatic Hyperplasia Diagnosis and Treatment Guideline, to provide evidence for taking measures to narrow the gap, then further enhance the urologists’ cognition for BPH, standard medical behaviors and improve diagnosis and treatment quality of patients with BPH.Methods:A cross-sectional survey study was carried out in31provinces regions (excluding Hongkong, Macao, Taiwan) in China. A random sample of5100Chinese urologists completed a structured questionnaire on their basic information and their preferences in diagnosis and treatment for patients with BPH.4774urologists were qualified for the analysis. We used Benign Prostatic Hyperplasia Diagnosis and Treatment Guideline (2011Edition) made by Chinese Urological Association (CUA) as the criteria to evaluate the medical behaviors of urologists. Data were entered into Epidata3.0and we performed all statistical analyses using SPSS version13.0and SAS version9.2with a priori significance of a=0.05. The statistical methods used analyzing the data were analysis of variance, chi-square test, non-conditional logistic regression analysis and two levels of logistic regression models.Results:1. The cognition agreement rates of the disease progression, clinical progressive manifestation, predictive factors of the progressive risk were respectively97.6%,43.4%,10.2%.2. The initial evaluation of BPH:Most urologists routinely performed digital rectal examination (93.4%), transrectal ultrasound (92.3%), residual urine volume (92.4%), uroflowmetry (89.2%), international prostate symptom score (IPSS)(88.5%), serum Prostate Specific Antigen (PSA)(78.6%), urinalysis (72.8%), quality of life (QOL)(68.1%), but the agreement rate of the recommended tests of CUA guidelines was low with only20.2%.3. The clinical treatment of BPH:The urologists grasped the BPH indications for surgical therapy well, medical treatment worse and watchful waiting worst. Almost all urologists (93.4%) believed that5-alpha reductase inhibitors (5ARIs) can reduce the progressive risk of BPH, at the same time the urologists gave them with the highest score in the efficacy of reducing prostate volume. In four kinds of drug treatment, combination therapy with an alpha-blocker and a5ARI was dominant in the drug treatment. When there was a need to discontinue taking a drug during combination therapy,85.5%of the urologists would disable the alpha-blocker,67.7%of them selected to disable after6months of combination therapy. For the surgical therapy, urologists performed transurethral resection of the prostate (TURP)(72.4%) the first most, transurethral plasmakinetic resection of the prostate (TUPKP)(19.8%) the second most, open prostatectomy, transurethral holmium laser resection of the prostate (HOLRP) and transurethral photoselective vaporization of the prostate (PVP) used less.4. The follow-up of patients with BPH:The agreement rate of the examinations and tests that were performed during the follow-up period for watchful waiting, medical treatment and postoperative patients with BPH was respectively7.8%,8.4%,44.8%. Accordingly, the leakage rate of IPSS was48.3%,50.7%,25.1%, the total leakage rate of IPSS was66.9%.5. Analysis of influencing factors of single level:The agreement rate of initial evaluation related to geographic location, urologists’ educational background and hospital level. The choice of surgical approach related to geographic location, age, gender, hospital level. The urologists’ variables had no effect on the IPSS test for patients during follow-up period.6. Analysis of influencing factors of two levels:After control for the regional variations, urologists’ educational background and hospital level related to the agreement rate of diagnosis, the urologists’ age and hospital level related to the choice of surgical approaches, the urologists’ variables had no affect on the IPSS test for patients during follow-up period.Conclusions:There were different degrees of variations between the urologists’ cognition, initial evaluation, treatment, follow-up of BPH and CUA best practice guidelines. The urologists’ diagnosis and treatment for patients with BPH were associated with their age, educational background, hospital level. Improving guideline adherence and reducing variation could standard medical behavior and improve BPH care quality. At the same time, this study will serve as an important reference for updating and revising the CUA guideline.