Coeurdacier P, Staerman F, Thoquenne G, Cipolla B, Guillé F, Lobel B
Service d'Urologie, C.H.R.U., Rennes.
Prog Urol. 1996 Feb;6(1):52-9.
A questionnaire was set to 250 general practitioners in the Brittany region, to determine the impact of information campaigns concerning benign prostatic hyperplasia (BPH) and prostatic cancer on their everyday approach to disorders of micturition in men over the age of 50 years. 225 questionnaires were interpretable. 75% of general practitioners systematically investigated the presence of disorders of micturition. In the presence of such symptoms, 76% of general practitioners conducted further investigations to exclude prostatic cancer. 89% of general practitioners performed first-line digital rectal examination, and 34% of them systematically performed this examination once a year. The investigations most frequently performed after digital rectal examination concerned the state of urine (50%) but only 30% of general practitioners used reagent dip-sticks and 43% ordered urine cultures. Other investigations consisted of transrectal ultrasonography (31%) an PSA assay (26%). 3% of PSA assays were ordered before digital rectal examination. Renal and vesical ultrasonography occupied 5th place, although distension of the upper urinary apparatus was a source of concern for 51% of general practitioners. In the presence of symptomatic BPH, general practitioners readily prescribed medical treatment (96%). They assessed the results of this treatment on the course of disorders of micturition (95%), digital rectal examination (91%), and PSA (50%). General practitioners are familiar with disorders of micturition after the age of 50 years. However, 25% of them do not systematically question patients about these symptoms. Digital rectal examination is now performed more frequently, although systematic examination of the prostate is rare (34%). PSA assay is not the doctor's first priority (3rd place in the list of examinations). Two examinations are rarely used and should be developed: reagent dip-sticks (30%) and renal and vesical ultrasonography (5th place). Only 4% of general practitioners did not prescribe any treatment in the case of uncomplicated BPH, which is not in line with current recommendations. There is certainly a need for better information of general practitioners, but this information is only valid when a consensus has been reached among urologists.
向布列塔尼地区的250名全科医生发放了一份调查问卷，以确定有关良性前列腺增生（BPH）和前列腺癌的宣传活动对他们处理50岁以上男性排尿障碍日常方法的影响。225份问卷可解读。75%的全科医生会系统地调查排尿障碍的存在情况。出现此类症状时，76%的全科医生会进一步检查以排除前列腺癌。89%的全科医生进行一线直肠指检，其中34%的医生每年会系统地进行一次此项检查。直肠指检后最常进行的检查是尿液状态检查（50%），但只有30%的全科医生使用试条，43%的医生安排尿液培养。其他检查包括经直肠超声检查（31%）和前列腺特异性抗原（PSA）检测（26%）。3%的PSA检测在直肠指检前进行。肾脏和膀胱超声检查排在第五位，尽管51%的全科医生担心上尿路扩张。出现有症状的BPH时，全科医生很容易就会开出药物治疗（96%）。他们根据排尿障碍的病程（95%）、直肠指检（9）和PSA（50%）来评估治疗效果。全科医生熟悉50岁以上男性的排尿障碍。然而，其中25%的医生不会系统地询问患者这些症状。现在直肠指检的频率更高了，不过对前列腺进行系统检查的情况很少见（34%）。PSA检测并非医生的首要选择（在检查清单中排第三位）。有两项检查很少使用，应该加以推广：试条（30%）和肾脏及膀胱超声检查（第五位）。在单纯性BPH的情况下，只有4%的全科医生未开出任何治疗药物，这不符合当前的建议。当然需要让全科医生获得更好的信息，但只有在泌尿科医生达成共识后，这些信息才有效。
