[Factors determining treatment strategies for patients with benign prostatic hyperplasia. The DUO study].
ABSTRACT The DUO study sought to identify the factors determining diagnostic and treatment strategies for benign prostatic hyperplasia (BPH) in daily practice.
Observational study conducted in France (from June 2004 through March 2005) among a representative sample of French urologists.
Two hundred two urologists included 1027 BPH patients (mean age: 68 years +/-9), 856 of whom were seen again six months later. The mean International Prostatic Symptom Score (IPSS) was 14.9 (+/-6.7) at inclusion and 10.5 (+/-6.7) at the follow-up visit. At inclusion, pharmacologic treatment was prescribed to 84% of patients, surgery was recommended to 13% and no treatment to 3%. Factors favoring surgery (versus drugs) were BPH severity (OR=2.5 for IPSS>or=20), patient choice (OR=2.5), expected quality of life improvement (OR=2.2), post-void residual (OR=2.1) and dribbling (OR=1.6). This choice was not associated with patient age, prostatic volume or active sex life. Choice of a 5alpha reductase inhibitor (versus alpha-blocker) was associated with large prostatic volume (OR=7.6), PSA results (OR=5.8), and patient age (OR=5.5 for >or=74 years, OR=2.1 for >or=68 years). Prescription of a combination of alpha-blocker plus 5alpha-reductase inhibitor (versus alpha-blocker alone) was associated with severity of BPH (OR=7.9), prostatic volume (OR=7.8), prevention of complications (OR=3.1), patient age (OR=3.0 if >or=74 years) and post-void residual (OR=2.3).
Both medical and surgical treatment of BPH resulted in improved IPSS scores at 6 months. Patient age and prostatic volume are reasons urologists prescribe 5alpha reductase inhibitors, but they do not affect the decision about surgical treatment. Surgery is performed in severe BPH or when patients choose surgery in the expectation of improving their quality of life. The factors determining treatment strategies identified in this study are patient age, BPH severity, prostatic volume, patients' wishes, PSA results and post-void residual.
Article: Outcomes and general health-related quality of life among patients medically treated in general daily practice for lower urinary tract symptoms due to benign prostatic hyperplasia.[show abstract] [hide abstract]
ABSTRACT: This study's aim was to describe and evaluate outcomes of medical strategies used for lower urinary tract symptoms (LUTS) treatment in general practice and to assess impact of LUTS on patients' general health-related quality of life (HRQoL). This cross-sectional observational study was conducted by French general practitioners. Eligible patients were males aged ≥50 years, diagnosed for at least one year and currently treated for LUTS due to benign prostatic hyperplasia (BPH). Several validated questionnaires were documented by patients to assess severity of LUTS (IPSS), specific quality of life (IPSS-Q8), impact of LUTS (BII), LUTS evolution (VNS) and general HRQoL (EQ-5D). Among 1,098 patients included, 82.7% were treated with monotherapies and 17.3% with combinations. Mean treatment duration was 5.2 ± 3.2 years, and 47.2% of patients had at least one treatment modification since initiation. Patients reported diminished quality of life (IPSS-Q8 ≥3) (42.3%), persisting symptoms (IPSS-score ≥12) (35.5%), symptoms worsening (VNS-score ≤-1) (18.8%) and high bother (BII-score ≥9) (2.6%). Globally, 52.8% had at least one of these unsatisfactory outcomes. Regarding general HRQoL, mean EQ-5D utility significantly decreased with LUTS severity (mild: 0.90 ± 0.12; moderate: 0.81 ± 0.21; and severe symptoms: 0.73 ± 0.25; P < 0.001). As well, all five-dimensions of EQ-5D were significantly altered in patients with moderate-to-severe LUTS (<0.001), especially 'Pain/Discomfort' and 'Anxiety/Depression'. In multivariate analyses including age and comorbidities, EQ-5D utility index remained negatively associated with each additional unit in the IPSS-score. This study shows that around half of BPH patients medically treated report unsatisfactory outcomes, suggesting consequential unmet medical needs in general practice. Also, moderate-to-severe LUTS significantly impact on general HRQoL.World Journal of Urology 09/2011; 30(3):419-26. · 2.41 Impact Factor