Stoevelaar H J, Van de Beek C, Casparie A F, McDonnell J, Nijs H G
Institute for Health Care Policy and Management, Erasmus University, Rotterdam, The Netherlands.
J Urol. 1999 Jan;161(1):133-8.
New treatment modalities for benign prostatic hyperplasia (BPH) have considerably altered the decision making process in daily clinical practice. Guidelines provide a framework for treatment choice but leave much room for physician personal opinions. We identified and quantified determinants of treatment choice for BPH among urologists focusing on urologist treatment preferences.
The study population consisted of 670 consecutive patients with BPH 50 years old or older newly referred to 1 of 39 urologists in a stratified sample of 13 hospitals throughout The Netherlands. Data on patient characteristics were retrieved from patient questionnaires (symptomatology, bothersomeness, sexual function), medical records (diagnostic outcomes, co-morbidity) and urologist questionnaire (initial treatment choice and main considerations for this decision). Urologist treatment preferences were inventoried using a mailed questionnaire. Polychotomous logistic regression analysis was used to study the impact of patient characteristics and urologist preferences on treatment choice.
Among the patient characteristics maximum flow rate, residual urine and prostate volume were strongly associated with the probability of surgery and watchful waiting. However, the influence of urologist preferences on actual decisions was also significant. Adjusted for case mix the differences in low and high preferences revealed a 2.2 times greater probability of surgery. For alpha-blockers and finasteride these ratios were 1.8 and 9.4, respectively. An additional independent effect was seen for urologist extent of experience.
The influence of urologist personal preferences on treatment choice in BPH is considerable. Given the different efficacy and side effects of the various treatments, further consensus development is needed to enhance appropriate treatment decisions and eliminate undue costs.
良性前列腺增生（BPH）的新治疗方式已在很大程度上改变了日常临床实践中的决策过程。指南为治疗选择提供了一个框架，但仍给医生个人意见留出了很大空间。我们针对泌尿外科医生对BPH治疗选择的决定因素进行了识别和量化，重点关注泌尿外科医生的治疗偏好。
研究人群包括荷兰13家医院分层抽样的39位泌尿外科医生新接诊的670例年龄在50岁及以上的连续性BPH患者。患者特征数据来自患者问卷（症状、困扰程度、性功能）、病历（诊断结果、合并症）以及泌尿外科医生问卷（初始治疗选择及该决定的主要考虑因素）。通过邮寄问卷来梳理泌尿外科医生的治疗偏好。采用多分类逻辑回归分析来研究患者特征和泌尿外科医生偏好对治疗选择的影响。
在患者特征中，最大尿流率、残余尿量和前列腺体积与手术和观察等待的可能性密切相关。然而，泌尿外科医生的偏好对实际决策的影响也很显著。经病例组合调整后，高低偏好之间的差异显示手术概率高出2.2倍。对于α受体阻滞剂和非那雄胺，这些比率分别为1.8和9.4。还观察到泌尿外科医生经验程度的额外独立影响。
泌尿外科医生的个人偏好在BPH治疗选择中影响颇大。鉴于各种治疗方法的疗效和副作用各不相同，需要进一步达成共识以促进恰当的治疗决策并消除不必要的费用。
