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Family Practice Advance Access published online on September 12, 2006
Family Practice, doi:10.1093/fampra/cml028
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© 2006 The Author(s)
Received November 22, 2005
Accepted May 23, 2006

Article

A decision aid for GPs for the treatment of elderly male patients with lower urinary tract symptoms (LUTS)

Roelf J. C. Norg 1 *, Piet J. M. Portegijs 1, Kees van de Beek 2, Onno van Schayck 1, and J. André Knottnerus 1

1 Department of General Practice, Care and Public Health Research Institute, Universiteit Maastricht, Maastricht, The Netherlands
2 Department of Urology, University Hospital Maastricht, Maastricht, The Netherlands

* To whom correspondence should be addressed.
Roelf J. C. Norg, E-mail: roelf.norg{at}hag.unimaas.nl


  Abstract

Background. GPs have four main treatment options for lower urinary tract symptoms (LUTS): watchful waiting, {alpha}-blockers, 5-{alpha}-reductase inhibitors or (referral for) surgery. Guidelines do not provide clear cut-off values for (combinations of) symptoms and physical examination results to decide which treatment is best.

Objective. (i) To develop a decision aid (‘checklist’) for GPs for the treatment of patients with LUTS. (ii) To assess its value for use in a primary care population.

Materials and methods. Population-based cross-sectional study. Included were subjects with uncomplicated LUTS for whom treatment in primary care may be appropriate. [International Prostate Symptom Score (IPSS) ≥8, no prior prostate surgery, prostate-specific antigen (PSA) value <10 ng/ml]. For each subject the appropriateness of surgery and {alpha}-blocker treatment was determined using a previously validated formalized international expert panel judgement. Regression models using data available in primary care were constructed to predict the panel judgement. Subsequently these models were transformed into simple checklists. Finally, the efficiency of these checklists was calculated.

Results. The best checklists consisted of age, symptoms severity, type of symptoms, a quality of life score and PSA value. Assuming one would like to provide at least 95% of the subjects for whom a certain treatment is appropriate with this treatment (i.e. ‘sensitivity’ of the checklist ≥95%), one can reach a positive predictive value of 50-60%.

Conclusion. Simple checklists based on the judgement of experts regarding the most appropriate therapy can help GPs to advise their patients of a rational treatment strategy.

Keywords: Benign prostatic hyperplasia; diagnosis; lower urinary tract symptoms; therapy.
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