Management of symptomatic BPH in Italy: Who is treated and how?

Objective: To investigate the management of symptomatic benign prostatic hy perplasia (BPH) in Italy. Methods: Information on diagnosis, medical and su rgical treatment was obtained from two different questionnaires independent ly mailed to urological centers in Italy. Data on drug treatments were obta ined from a national database. General practitioner (GP) clinical practice patterns were obtained from a panel discussion between general practitioner s and urologists. Results: First line medical treatment is currently undert aken by GPs more often and to a smaller extent by urologists to whom patien ts can self-refer. Primary care diagnostic algorithm consists of patient's interview, physical rectal examination and urinalysis. The main reason for referral of a BPH patient to the urologist by GPs appears to be an unsatisf actory outcome of first line medical therapy. Examination of the suprapubic area plus rectal examination is always performed by urologists during phys ical examination while evaluation of motor and sensory function is carried out in 28% of patients only. Voiding diary and I-PSS score are currently us ed by 17 and 65% of urologists, respectively. Urinalysis, plasma creatinine and prostate specific antigen (PSA) are used in 100, 94 and 89% of cases, respectively. Ninety-four percent of urologists use uroflowmetry with evalu ation of post voiding residual by ultrasound. Pressure-flow studies are use d in selected cases by 89% of urologists. Ultrasound imaging of the kidney, bladder and prostate transrectal ultrasound (TRUS) is reported as current practice in 79, 71 and 53% of questionnaires, respectively. Over six millio n medical consultations with prescriptions for BPH were carried out in 1998 accounting for 190,600,000 drug treatment days. Prescriptions for 5 alpha- reductase inhibitors accounted for 71,400,000 days of treatment, a-blockers for 104,000,000 and plant extracts for 15,300,000 days. In 24 to 28% of ca ses more than one drug was prescribed. Indications for invasive treatment r ely on symptoms (98%), presence of BPH complications (90%), flowmetry (65%) , residual urine (50%), prostate volume (40%) and urodynamics (20%). About 10% of patients consulting the outpatient clinics were allocated to watchfu l waiting, 50% received pharmacological treatment and 40% invasive treatmen t. Analysis of invasive treatment options resulted in 62% of patients recei ving transurethral resection of the prostate (TURP), 29% open prostatectomy and the remaining 9% received various forms of minimally invasive treatmen ts. Patients were most commonly followed up for 3 months with 62% of patien ts followed up at one year post-operatively and then yearly. Conclusions: O ur survey suggests that the current cl in ica I practice of primary and sec ondary care physicians is in line with the recommendations of the IVth Inte rnational Consultation on BPH. However, Italian urologists seem to use less frequently symptom scores and voiding diaries than recommended. It seems t hat open surgery is more frequently used in Italy than in other European co untries. Minimally invasive treatments remain a very small portion of inter ventions for the management of BPH in Italy. Fifty-five percent of patient days of treatment are alpha-blockers, 37% is finasteride. The share of alph a-blockers has dramatically grown with the introduction of the first prosta te-selective agent, tamsulosin. Copyright (C) 1999 S. Karger AG, Basel.