The urological management of men with lower urinary tract symptoms, recorded using an interactive computer program.
OBJECTIVE
To analyse the level of agreement among urologists from the industrialized world in the management of men with lower urinary tract symptoms (LUTS).


METHODS
Thirty-three urological departments participated in the study. A computer program was used to provide an unbiased format of 18 simulated cases of men with LUTS which individual urologists then evaluated diagnostically and made therapeutic decisions about their management. The management of the patients was assessed for the probability that a diagnostic test was used, that a therapy was offered to a particular patient, the first-choice therapies selected, the mean cost and range for the diagnostic process per patient and the number of first-choice therapies offered by one urologist for all the patients. Various discriminators for these therapeutic decisions were evaluated, analysing the correlations between the information provided by the diagnostic tests and the probability of a particular therapy.


RESULTS
For the 18 patients, the urologists, as a first choice, treated a mean (SD, range) of 8.3 (3.4, 3-16) patients with TURP, 3.9 (3.6, 0-11) with alpha-blockers, 2.3 (1.7, 0-6) with watchful waiting and 1.7 (2.4, 0-9) with finasteride. The other therapy options were only offered as a first choice by a few of the urologists in a few of the cases. The mean (SD, range) cost per patient of the diagnostic process was US$ 594 (209, 326-1350).


CONCLUSIONS
There was considerable disagreement among the urologists about the management of men with LUTS, which included both the choice of diagnostic tests and the criteria for offering therapy to patients. If such disagreement prevails generally, it may be detrimental for the outcome of patients seeking medical attention for LUTS, and the cost of the medical care of these patients will be unnecessarily high.
Hansen
M V
MV
Department of Surgery, Halmstad Hospital, Sweden.
Zdanowski
A
A
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D003198:Computer Simulation; D003365:Costs and Cost Analysis; D003657:Decision Making; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D018120:Finasteride / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016544:Patient Simulation; D011468:Prostatectomy / Q000379:methods; D014555:Urination Disorders / Q000175:diagnosis / Q000628:therapy; D014570:Urologic Diseases / Q000175:diagnosis / Q000628:therapy*
D000317:Adrenergic alpha-Antagonists; D004791:Enzyme Inhibitors; D018120:Finasteride