Urologists better for management and treatment of benign prostatic hyperplasia

Last Updated: 2015-03-26

By Lisa Rapaport

NEW YORK (Reuters Health) - Urologists appear better than other physicians at diagnosis and treatment of benign prostatic hyperplasia (BPH), a Korean study suggests.

"Urologists have more experience in the diagnosis and treatment of prostate diseases, including BPH, than general physicians or family medicine doctors," senior study author Dr. Hwancheol Son, of the College of Medicine at Seoul National University, told Reuters Health by email. "My study showed better diagnostic evaluation and the differences in drug combinations with urologists."

Son and colleagues reviewed data on 390,767 individuals defined as new BPH patients in 2009, using records from the Health Industry Representatives Association. Of these, 240,907 (61.7%) were diagnosed by urologists. The remaining 149,860 patients were diagnosed by other clinicians, most often internists, but also general surgeons, dermatologists, orthopedists, and family medicine practitioners.

The average age of patients treated by urologists was 57.4, compared with 61.6 for nonurologists. There were more people over the age of 70 seen by nonurologists.

A greater proportion of the urologists' patients lived in big cities, 52.3% versus 45.2% for nonurologists. At the same time, more people seen by nonurologists lived in rural areas, 14.2% versus 7.1% for urologists.

Hypertension was significantly more common with the nonurologists' patients (32.8% versus 25.4%, p<0.0001). So was diabetes mellitus (13.7% versus 9.9%, p<0.0001) and malignancy (8.4% versus 5.0%, p<0.0001).

The initial diagnostic evaluation of new BPH patients differed significantly between the two groups.

With urologists, 18.5% of patients got digital rectal exams as part of the initial evaluation, compared with 6.1% of people seen by nonurologists. The difference for urine analysis was 68.9% versus 47.6%; it was 57.8% versus 39.2% for prostate-specific antigen screening; and 29.2% versus 6.9% for uroflowmetry.

Nonurologists were more likely to check serum creatinine, doing this for 40.5% of patients versus 25.5% for urologists.

The rate of drug prescription after the initial diagnosis was higher in the urologist group, while periods of drug prescription were longer for nonurologists.

No medication was prescribed for 43.9% of the nonurologist group, compared with 33.9% in the urologist group. Prescription days were typically 15.4 with urologists and 17.9 with non-urologists.

The use of alpha-blockers was common in both groups. Urologists prescribed combination therapy of an alpha-blocker with a 5-alpha reductase inhibitor as a second choice, while the nonurologists preferred monotherapy with a 5-alpha reductase inhibitor.

Incidence of surgery during one-year follow-up was also significantly different between the urologists and the nonurologists, with 3,213 cases versus 646 cases, respectively.

Transurethral resection of the prostate (TURP) was the most common surgery, followed in descending order by laser, hyperthermia, and open prostatectomy. In the comparison of each type of surgery, all except prostatectomy were significantly lower in the group treated by nonurologists.

One limitation of the study is the reliance on insurance claims data, which might underestimate the BPH population if some patients are not diagnosed or treated in health care institutions, the authors wrote in the paper, published online March 3 in the Korean Journal of Urology. There might also be misclassification of disease or coding errors. And, the data only contained items covered by insurance.

Many differences in the two cohorts might be related to the reliance on an administrative data set, Dr. Kevin McVary, chair of urology at the Southern Illinois University School of Medicine, told Reuters Health in an email.

"Basically those that seek help from a urologist may have much more severe disease than those who are treated by primary care MDs," said McVary, who wasn't involved in the study. "This basic issue then trickles down into the differences in treatment between groups."

The Health Industry Representatives Association and the Korean Prostate Society supported this research. The authors reported no disclosures.

SOURCE: http://bit.ly/1Nk1xXp

Korean J Urol 2015.