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 particip ated in the study, A computer program was used to provide an unbiased format of 18 simulated cases of men with LUTS which individual urologi sts 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 offer ed to a particular patient, the first-choice therapies selected, the m ean cost and range for the diagnostic process per patient and the numb er of first-choice therapies offered by one urologist for all the pati ents. Various discriminators for these therapeutic decisions were eval uated, analysing the correlations between the information provided by the diagnostic tests and the probability of a particular therapy, Resu lts For the 18 patients, the urologists, as a first choice, treated a mean (so, range) of 8.3 (3.4, 3-16) patients with TURF, 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, T he mean (so, range) cost per patient of the diagnostic process was US$ 594 (209, 326-1350). Conclusion There was considerable disagreement a mong the urologists about the management of men with LUTS, which inclu ded both the choice of diagnostic tests and the criteria for offering therapy to patients. If such disagreement prevails generally, it may b e detrimental for the outcome of patients seeking medical attention fo r LUTS, and the cost of the medical care of these patients will be unn ecessarily high.