[Variation in the diagnosis and treatment of benign prostatic hyperplasia in urological practice].
OBJECTIVE
To analyse practice variation among urologists and its determinants with respect to diagnostics and therapy choice in benign prostatic hyperplasia (BPH).


METHODS
Cross-sectional.


METHODS
Stratified sample of 12 urological practices throughout the Netherlands.


METHODS
On 670 consecutive, newly referred BPH patients > or = 50 years, data were collected about symptomatology, discomfort and sexual functioning (patient questionnaire), diagnostic procedures and outcomes (medical record), and (considerations for) therapy choice (urologist questionnaire). Characteristics of patients as well as of urologists were integrally studied to explain the variation.


RESULTS
With respect to diagnostics, highest variation (interquartile ranges) was found for ultrasonography of the prostate (19-86%), kidneys (19-68%), and bladder (42-91%), and lowest variation for digital rectal examination (97-100%) and blood tests and urinalysis (88-100% and 86-99% respectively). For therapy choice, interquartile ranges were 24-42% (surgery), 32-49% (watchful waiting), 5-29% (alpha-blockers), and 0-17% (5-alpha-reductase-inhibitor). Variation in diagnostics was associated with characteristics of urologists and work setting as well as of patients. For differences in therapy choice, symptomatology, discomfort, sexual activity, peak flow, volume of residual urine, prostate volume, comorbidity, experience of the urologist, and the type of hospital were the most important explanatory variables.


CONCLUSIONS
Variation in both diagnostics and therapy choice is considerable. This variation is associated with characteristics of patients as well as of urologists and work setting.
Stoevelaar
H J
HJ
Erasmus Universiteit, Instituut Beleid en Management Gezondheidszorg, Rotterdam.
van de Beek
C
C
Casparie
A F
AF
Nijs
H G
HG
McDonnell
J
J
Janknegt
R A
RA
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000368:Aged; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D018120:Finasteride / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011468:Prostatectomy; D011470:Prostatic Hyperplasia / Q000175:diagnosis* / Q000628:therapy*; D012494:Sampling Studies; D014563:Urodynamics
D000317:Adrenergic alpha-Antagonists; D004791:Enzyme Inhibitors; D018120:Finasteride
Variatie in diagnostiek en behandeling van benigne prostaathyperplasie in de urologische praktijk.