Survey of the management of benign prostatic hyperplasia by Chinese urologists

Abstract

Objective The aim of this study was to investigate the understanding and application of the Chinese Urological Association (CUA) guidelines of Benign Prostatic Hyperplasia (BPH) (2011 edition) in Chinese urologists. Methods The survey was conducted between September, 2012 and November, 2012. Questionnaires designed by the CUA were used to investigate the understanding and management of BPH in CUA-registered urologists, who work in clinic for at least 20 hours per week. Data, including general characteristics of the urologists, understanding of BPH, BPH diagnosing in suspected patients, BPH treatment, and follow up, were collected. 7500 questionnaires were distributed. A total of 4 897 participants responded (response rate 70.0%). 86 questionnaires with incomplete information and 37 duplicate questionnaires were excluded. And 4 774 validate questionnaires were included for the analysis, finally. The mean age of those investigated urologists was (39.9±9.2) years old. Among them, 3 802 (81.0%) urologists work in the tertiary hospital, 878 (18.7%) urologists work in the secondary hospital and 12 (0.3%) urologists work in the other hospital. The district distribution in those urologists included 455 (9.6%) in northeast china, 812 (17.1%) in north china, 1 696 (35.6%) in east china, 869 (18.2%) in south china, 634 (13.3%) in southwest china, 295 (6.2%) in northwest china. 1 835 (43.8%) urologists have less than ten years working experience. 1 505 (35.9%) urologists have 11 to 20 years working experience. The 21 to 20 years working experience was reported in 705 (16.8%) urologist. And the other 149 (3.5%) urologists have working experience more than 31 years. The educational background in this study included doctor degree in 732 (15.8%) urologists, master degree in 1 729 (37.4%) urologists, bachelor degree in 2 067 (44.7%) urologists and college degree in 101 (2.1%) urologists. The position composition included 834 (18.2) directors, 1 371 (30.0%) deputy directors, 1 605 (35.1%) attendings and 765 (16.7%) residents. The data were analyzed using rank-sum test, 2 test, or Fisher′s exact test. Results The understanding of BPH clinical progression and progression-associated risk factors in Chinese urologists was poor. Compared to the guidelines, the rate of consistent were only 43.4% (2 023/4 665) and 10.2% (477/4 660), respectively. The initial evaluation methods for suspected BPH patients were in low consistency with the guidelines (20.2%, 845/4 181) and were inconsistent among different areas [66.5% (290/436) in northeast china, 64.7% (556/859) in south china, 55.6% (158/284) in northwest china, 55.1% (922/1 672) in east china, 54.7% (435/795) in north china, 48.0% (296/617) in southwest china]. The participants showed poor understanding of the primary goal of treatment for BPH (4.9% consistent, 229/4 666) and the criteria about watchful waiting (22.5% consistent, 1 051/4 674). However, the understanding of surgical indications for BPH was good (94.6% consistent, 4 410/4 663). The therapeutic effects of 5α-reductase inhibitor for BPH were acknowledged by 93.4% (4 388/4 699) participants. The consistent rate with the guidelines of follow-up examinations was low for patients with watchful waiting (7.8%, 355/4 531), medication treatment (8.4%, 373/4 432), and surgery (44.8%, 2 105/4 702). Conclusions The understanding of the CUA BPH guidelines is poor in Chinese urologists. Target training in the specific urologists with tailored contents is necessary. Key words: Benign prostatic hyperplasia; Urologists; Questionnaire