VARIATIONS IN THE DIAGNOSTIC PROCESS AMONG UROLOGISTS IN ONE REGION RECORDED USING AN INTERACTIVE COMPUTER-PROGRAM

To analyse how male cases suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are handled within a well-defined health-care region in Scandinavia, an interactive compute r program containing 20 cases suffering from LUTS due to BPH was used for recording the diagnostic process and the treatment decisions; 37 o ut of a total of 50 urologists practicing within a small health region participated. The diagnostic process varied considerably due to a var ying choice of diagnostic tests and the large differences in interpret ing the qualities described by the tests. The probability that a patie nt would be offered a treatment within the region was analysed. For ma ny patients the probability that a treatment was chosen was in the vic inity of 50%. No treatment probability was correlated to the symptom s core of the patients. While the probability that a transurethral prost atic resection would be offered to the patients within the region was correlated significantly to urodynamic variables, residual urine and t o cystoscopy findings, the probability that transurethral microwave or finasteride therapy would be offered was not correlated to any of the described qualities. The costs of the diagnostic process in all the p atients incurred by each of the urologists varied by up to 500%. It wa s estimated that approximately 40% of the costs involved diagnostic te sts that did not influence the decision to offer or not to offer treat ment. In conclusion, the enormous variations in the handling of the ca ses recorded in the study stress the need that a management formula sh ould be used in the handling of patients with LUTS.