McNicholas T A
Department of Urology, Lister Hospital, Stevenage, UK.
Eur Urol. 2001;39 Suppl 3:26-30. doi: 10.1159/000052564.
The current clinical practice patterns for the management of LUTS suggestive of BPO in the US and in various European countries will be reviewed.
Information was obtained from published scientific articles and IMS/GERS market analysis data.
Community-based surveys demonstrate that the prevalence of moderate to severe LUTS in elderly men is high and increases with age. The role of the GP in the initial management of LUTS is growing. In France, Italy and the UK, most patients with LUTS initially visit a GP. More and more patients in the US also first seek medical advice from a primary care physician or an internal medicine specialist. In Germany, both GPs and office-based urologists are involved in the initial management of LUTS. In Poland and Spain, office-based urologists initiate primary therapy for LUTS, although a trend towards involvement of GPs is also seen, especially in Poland. The shift in the initial management of LUTS from secondary to primary care accompanies a decreased incidence of surgery and a growing demand for medical therapy. Currently, there are considerable differences between the medical management of LUTS suggestive of BPO across Europe in real life practice. For example phytotherapy is particularly popular in countries such as Germany, France and Spain, whereas finasteride is more commonly used in Italy, Poland and the UK. alpha(1)-Adrenoceptor antagonists are used in most of these countries as the primary treatment modality. The data furthermore suggest that the current management of patients is often more opinion- than evidence-based, which may at least partly be due to the fact that data on long-term effectiveness of treatment options in real life clinical practice are largely lacking.
[corrected] Due to the ageing and longevity of the population, the costs associated with the management of LUTS suggestive of BPO will rise in the future, whereas healthcare budgets will be relatively restricted. In order to improve cost-effective management of LUTS, more and better studies are needed in real life practice in primary care. These studies should not only be based on classical efficacy and safety data, but also on effectiveness of treatment in the long-term and the associated costs.
回顾美国和欧洲各国当前对提示良性前列腺增生（BPO）的下尿路症状（LUTS）的临床治疗模式。
从已发表的科学文章以及IMS/GERS市场分析数据中获取信息。
基于社区的调查表明，老年男性中重度LUTS的患病率很高，且随年龄增长而增加。全科医生（GP）在LUTS初始治疗中的作用日益增强。在法国、意大利和英国，大多数LUTS患者最初会去看全科医生。在美国，越来越多的患者也首先向初级保健医生或内科专家寻求医疗建议。在德国，全科医生和门诊泌尿科医生都参与LUTS的初始治疗。在波兰和西班牙，门诊泌尿科医生启动LUTS的初始治疗，不过也出现了全科医生参与度增加的趋势，尤其是在波兰。LUTS初始治疗从二级医疗向初级医疗的转变伴随着手术发生率的下降和药物治疗需求的增加。目前，在现实生活实践中，欧洲各国对提示BPO的LUTS的药物治疗存在相当大的差异。例如，植物疗法在德国、法国和西班牙等国特别流行，而非那雄胺在意大利、波兰和英国更常用。α1肾上腺素能受体拮抗剂在这些国家中的大多数被用作主要治疗方式。数据还表明，目前对患者的治疗往往更多地基于观点而非证据，这可能至少部分是由于在现实生活临床实践中缺乏关于治疗方案长期有效性的数据。
由于人口老龄化和寿命延长，未来与提示BPO的LUTS管理相关的成本将会上升，而医疗保健预算将相对受限。为了提高LUTS的成本效益管理，在初级保健的现实生活实践中需要更多更好的研究。这些研究不仅应基于经典的疗效和安全性数据，还应基于长期治疗效果及相关成本。
