The evaluation and treatment strategy of male lower urinary tract symptoms in the primary care setting

Aim: to find out the patterns of evaluation and treatment of lower urinary tract symptoms (LUTS) in males aged 40 or older in the primary care setting. Objectives: to figure out how primary care physicians (PCPs) learn about the LUTS of their male patients, how do they evaluate these symptoms and which of the affected patients they refer to urologists. Subjects and methods: a special questionnaire was used to question 62 PCPs working in the Kaunas city family medicine residency bases of the Lithuanian University of Health Sciences. The gathered data was analysed statistically using the IBM SPSS software package. Results: 69% of the PCPs most frequently found out about the LUTS of their male patients when the patient complained about them, 24% inquired about LUTS systematically. While collecting information about LUTS 78% of the PCPs asked various questions concerning the symptoms, 7% used special scales. When evaluating LUTS 58% of the PCPs didn’t use special scales, 39% used the International Prostate Symptom Score (IPSS). When asked to evaluate the LUTS severity of a patient which complains of mild LUTS only 5% of the PCPs chose the correct answer. When benign prostate hyperplasia (BPH) is the suspected cause of LUTS 95% of the PCPs mentioned performing a urinalysis, 88% a blood prostate specific antigen (PSA) test, 32% a blood test, 3% a urine culture and 2% a digital rectal examination (DRE). Concerning urologist referrals, PCPs usually refer 100% of their patients with suspected BPH, 45% with suspected urethral inflammation, 22% with uncomplicated chronic cystitis and 8% with acute cystitis. When deciding whether to refer patients with LUTS to the urologist or not, the main deciding factor for the PCPs is the existence of LUTS, with abnormal test results, suspected non infectious origin of LUTS and the severity of symptoms having less effect and the wishes of the patient himself coming in last. However, 82-84% of the PCPs tend to comply with the patient’s wishes concerning an urological referral. Conclusions: The majority of the PCPs don’t systematically inquire about possible LUTS of their patients, collect information concerning LUTS without using special scales and tend to evaluate the severity of LUTS inaccurately. When PCPs suspect BPH most often they perform a urine test and a PSA test and almost never a DRE. The PCPs tend to refer patients which should be treated in the primary care setting to urologists and to give into the demands of the patient for such consultations. Recommendations: systemically inquire about LUTS concerning all patients aged 40 and over. Promote PCPs to perform a DRE more often on patients with LUTS. Only refer patients to urologists when there’s a real necessity. Adjust the current laws dealing with BPH treatment to give more rights to the PCPs