title: Diagnosis and treatment patterns of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia in Murjani General Hospital, Central Kalimantan, Indonesia.
abstract: BACKGROUND
  The aim of this study was to describe the diagnosis and treatment patterns of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and evaluate their appropriateness in an area without an urologist and with limited resources, such as the area covered by Murjani General Hospital, Sampit, Indonesia.
  
  
  METHODS
  This descriptive study used data collected from medical records of patients who were diagnosed with LUTS suggestive of BPH in Murjani General Hospital between September 2013 and August 2015.
  
  
  RESULTS
  There were 89 patients. Their mean age was 64.5 years. The most common chief complaint was inability to void (59.6%), followed by frequency (10.1%). Diagnostic evaluations such as symptom scoring (1.1%), frequency-volume chart (0%), digital rectal examination (3.4%), urinalysis (5.6%), and prostate-specific antigen (0%) were used rarely or never, while renal function assessment (37.1%) and imaging of the prostate (68.5%) and upper urinary tract (65.2%) were used more often. Overall, the treatment that was administered most often was indwelling catheterization (25.8%); only 19.1% visited a urologist following a referral by the physician, although 41.6% were referred to a urologist. There were 40.4% of patients with an indication for surgery, mostly in the form of recurrent or refractory urinary retention (83.3%). In this group of patients, only 38.9% received appropriate treatment in the form of open prostatectomy by a general surgeon (16.7%) or were referred to a urologist (22.2%), while 50% of them were managed with chronic indwelling catheterization.
  
  
  CONCLUSIONS
  All patients received substandard diagnostic evaluations, with a pattern of preference toward imaging studies over more basic examinations for LUTS-BPH. The high frequency of indwelling catheterization in overall and inappropriate treatment in the group of patients with an indication for surgery showed that patients received suboptimal treatment. Improvements in various aspects are required to optimize the management of LUTS suggestive of BPH in Murjani General Hospital.
authors.affiliation: Emergency Department, Murjani General Hospital, Sampit, Indonesia.
authors.forename: Robert Adrianto
authors.initials: RA
authors.lastname: Raharjo
keywords: Benign prostatic hyperplasia; Developing countries; Lower urinary tract symptoms; Physician's practice patterns; Standard of care