Urology Service, Hospital Universitario Puerta de Hierro-Majadahonda, c/Manuel de Falla no. 1, Majadahonda, Madrid, Spain.
Int J Clin Pract. 2009 Aug;63(8):1192-7. doi: 10.1111/j.1742-1241.2009.02092.x. Epub 2009 Jun 24.
Effective treatment of benign prostatic hyperplasia (BPH) improves lower urinary tract symptoms (LUTS) and patient quality of life, and reduces the risk of complications arising from disease progression. However, treatment can only be initiated when men with BPH are identified by accurate diagnostic tests. Current evidence suggests that diagnostic procedures employed by primary care physicians vary widely across Europe. The expected increases in BPH prevalence accompanying the gradual aging of the population, coupled with greater use of medical therapy, mean that general practitioners (GPs) are likely to have an increasingly important role in managing the condition. The GP/primary care clinic is therefore an attractive target location for strategies designed to improve the accuracy of BPH diagnosis. The Diagnosis Improvement in Primary Care Trial (D-IMPACT) is a prospective, multicentre, epidemiological study that aims to identify the optimal subset of simple tests applied by GPs in the primary care setting to diagnose BPH in men who spontaneously report obstructive (voiding) and/or irritative (storage) LUTS. These tests comprise medical history, symptom assessment with the International Prostate Symptom Score questionnaire, urinalysis, measurement of serum levels of prostate-specific antigen and subjective GP diagnosis after completing all tests including digital rectal examination. GP diagnoses and all other tests will be compared with gold-standard diagnoses provided by specialist urologists following completion of additional diagnostic tests. D-IMPACT will establish the diagnostic performance using a non-subjective and reproducible algorithm. An adjusted and multivariate analysis of the results of D-IMPACT will allow identification of the most efficient combination of tests that facilitate accurate BPH diagnosis in the primary care setting. In addition, D-IMPACT will estimate the prevalence of BPH in patients who present spontaneously to GPs with LUTS.
良性前列腺增生症（BPH）的有效治疗可以改善下尿路症状（LUTS）和患者的生活质量，并降低疾病进展引起并发症的风险。然而，只有通过准确的诊断测试才能确定患有 BPH 的男性，才能开始治疗。目前的证据表明，欧洲各地的初级保健医生使用的诊断程序差异很大。随着人口逐渐老龄化，预计 BPH 的患病率将会增加，再加上更多地使用药物治疗，这意味着全科医生（GP）在管理这种疾病方面可能会发挥越来越重要的作用。因此，GP/初级保健诊所是改善 BPH 诊断准确性的策略的一个有吸引力的目标地点。初级保健中诊断改进试验（D-IMPACT）是一项前瞻性、多中心、流行病学研究，旨在确定 GP 在初级保健环境中用于诊断自发性报告梗阻性（排尿）和/或刺激性（储存）LUTS 的男性的 BPH 的最佳简单测试组合。这些测试包括病史、国际前列腺症状评分问卷的症状评估、尿液分析、前列腺特异性抗原血清水平的测量以及在完成包括直肠指检在内的所有测试后进行的主观 GP 诊断。GP 诊断和所有其他测试将与泌尿科专家完成额外诊断测试后提供的黄金标准诊断进行比较。D-IMPACT 将使用非主观和可重复的算法确定诊断性能。对 D-IMPACT 结果的调整和多变量分析将确定在初级保健环境中促进准确 BPH 诊断的最有效测试组合。此外，D-IMPACT 将估计向 GP 自发报告 LUTS 的患者中 BPH 的患病率。
