Diagnosis and Assessment of BPH: What Should Be Done? A Glance at International Clinical Practice Guidelines

Abstract

Purpose: Clinical Practice Guidelines (CPGs) have gained recent popularity as they are meant to minimise the disparity between what clinicians do and what evidence there is to support them. Benign Prostatic Hyperplasia (BPH) (and associated Lower Urinary Tract Symptoms) is a typical clinical area where variations in diagnostic practice are common, and no agreed standards exist. Over the last decade a number of national and supra-national CPGs have been developed that provide advice on the management of BPH. We have subjected 2001 web-published CPGs on BPH to an appraisal against agreed methodological criteria and content analysis. Materials and methods: An electronic search (complemented by a hand-search) was used to identify 2001 web-based national and supra-national CPGs on BPH. Two independent assessors undertook content analysis and methodological appraisal of the CPGs using a validated instrument. Results: Eight CPGs were identified. There was much variation in both the CPG quality and the number and type of diagnostic tests recommended. The variation in recommendations may be explained by the differences in overall and methodological quality observed, as high-quality CPGs tended to recommend fewer diagnostic tests. All CPGs agreed that patient history and physical examination (including a DRE) should be performed on all symptomatic men and that patients’ symptoms should be assessed using a validated symptom score, e.g. IPSS. Other diagnostic tests were not unanimously recommended. Conclusion: BPH diagnostic management is a rather vague area and guidelines could be useful in setting recommendations based on the best available evidence. However, analysis of different guidelines showed a significant variation in their recommendations that could be explained by their overall and methodological quality.