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Diagnosis of BPH and treatment of LUTS among GPs: a European survey

By F. Montorsi and D. Mercadante.

International Journal of Clinical Practice, February 2013, Volume 67, Issue 2, Pages 114-119


Aims of the study:
This survey was conducted in France, Germany, Italy, Spain and UK, with the aim to assess diagnosis and therapy of BPH patients in clinical practice.

Methods used to conduct the study:
A selected cohort of 455 general practitioners (GPs) in Europe were asked to report information on BPH patients with lower urinary tract symptoms (LUTS), including patient characteristics, diagnostic procedures, severity of illness, symptoms duration and underlying conditions. The GPs provided data relating to 886 patients.

Results of the study:
The diagnostic work-up included description of symptoms (74.9–85.1%), rectal examination (55.4–82.1%) and the determination of PSA (79.1–94.7%). Transrectal sonography was popular in Italy and France (51.1% and 55.9%, respectively), less so in Germany (15.3%) and Spain (13.1%) and not at all in the UK (2.3%). At diagnosis, the most common symptom was nocturia (71–88%), followed by frequency (15–79%), urgency (43–68%) and weak stream (47–64%). The most common combination was the triad nocturia–frequency–feeling of incomplete emptying (22–31%). The mean ± SD LUTS severity score was similar in all countries: The main aim of treatment was the resolution of nocturia, which had an average score that reflected an important need (> 3.5) closely followed by frequency (3.3–3.9).

Conclusions drawn from the study and clinical implications:
This survey has shown that the most common LUTS is nocturia. Analyses of the symptoms’ pattern revealed that the most common combination appears to be the triad nocturia-frequency-feeling of incomplete emptying. An association between LUTS and heart disease, diabetes and hypertension suggests that the pharmacological treatment should be devoid of effects on the cardiovascular system. With alpha blockers as first line treatment of LUTS, respondents were more concerned with hypotensive episodes resulting in falls, rather than about other typical side effects (e.g. ejaculation disorders and lowered libido). The survey highlights educational needs in diagnostics