[Appropriate treatment of benign prostatic hyperplasia; refining the indications for treatment by systematic analysis of expert opinion].

OBJECTIVE

To assess systematically the opinion of urology experts regarding the appropriateness of indications for treatment of benign prostatic hyperplasia (BPH) and to evaluate the potential use of these expert opinions for the refinement of treatment guidelines.

DESIGN

Modified Delphi procedure.

METHODS

A panel of 12 Dutch urologists judged the appropriateness of three common treatments (surgery, alpha-adrenergic antagonists, finasteride) for 1152 hypothetical cases of BPH. These cases consisted of all combinations of 9 diagnostic characteristics considered relevant to treatment choice. The study population was restricted to patients for whom current (evidence-based) guidelines do not provide clear indications on the most appropriate treatment. The panel members individually rated the appropriateness of the three active treatments using a 1 to 9 scale, each in comparison with 'watchful waiting'. By combining the results on agreement and appropriateness, aggregate panel judgements were calculated for each indication (appropriate, inappropriate, uncertain). The relationship between diagnostic characteristics and panel opinions was studied using logistic regression methods.

RESULTS

For patients without previous treatment for BPH, surgery was considered appropriate in 44% of cases. For alpha-blocking drugs and finasteride, these values were 70% and 3% respectively. Logistic regression analysis revealed a strong and consistent relationship between the several diagnostic characteristics and the panel judgement 'appropriate indication'.

CONCLUSION

Systematic analysis of clinical expertise can offer a meaningful contribution to the refinement of indications for BPH treatments.