ABSTRACT
BACKGROUND: Uroflowmetry and ultrasound scanning of the post-void residual volume are diagnostic instruments in specialist urological care of men referred with lower urinary tract symptoms (LUTS). We hypothesized that implementing uroflowmetry and post-void ultrasound bladder scanning in primary care for men with LUTS will reduce the number of referrals to urologists. OBJECTIVE: To assess the effect on referrals to urologists for new male patients over 50 years of age with LUTS when performing uroflowmetry and post-void ultrasound bladder scanning in primary care. METHODS: A cluster randomized controlled trial was conducted among Dutch general practitioners (GPs). The GPs enrolled male patients with the first-time presentation of LUTS, these were randomized to primary-care treatment with or without uroflowmetry and post-void bladder scanning. Primary outcome: percentage of patients referred to urologists within 3 and 12 months. Secondary outcomes: changes in the International Prostate Symptom Score (IPSS) and the IPSS-Quality of Life, patient satisfaction and urologic medication usage after 12 months. RESULTS: Four GPs were randomly assigned to the intervention group (132 patients) and seven to the control group (212 patients). The percentage of patients referred to urologists did not differ significantly between the intervention group vs the control group: within 3 months 19.7% versus 10.4% (OR 1.9, 95% CI 0.8 to 5.0), and within 12 months 28.8% versus 21.2% (OR 1.5, 95% CI 0.9 to 2.5). CONCLUSIONS: Performing uroflowmetry and ultrasound bladder scanning in primary care as additional diagnostic tools do not reduce the number of referrals to urologists. We do not recommend using these diagnostic tools in general practice in the diagnostic work-up of these patients.
Subject(s)
Lower Urinary Tract Symptoms , Urinary Bladder , Humans , Lower Urinary Tract Symptoms/diagnostic imaging , Male , Primary Health Care , Quality of Life , Ultrasonography , Urinary Bladder/diagnostic imagingABSTRACT
RATIONALE, AIMS AND OBJECTIVES: Lower urinary tract symptoms (LUTS) are common problems among men, but only a small proportion actually visit their general practitioner (GP). This study aims to gain insight into the reasons why men visit a doctor, and their expectations. METHODS: We opted to perform a qualitative study with semi-structured interviews among men aged over 50 years who consulted their GP because of suffering from LUTS. All interviews were fully transcribed and coded and analysed by two researchers using ATLAS.ti. RESULTS: We interviewed 18 men between the ages of 52 and 80. Frequently mentioned reasons for seeking help can be grouped under three main themes: a wish for reassurance about not having prostate cancer, the nuisance of symptoms such as nycturia and being triggered by public information about LUTS. Most participants lacked an understanding of the cause and prognosis of their symptoms. CONCLUSION: The main reasons to seek primary medical care are the need for reassurance and the nuisance of symptoms, especially nycturia. Overall, the patients show remarkably poor knowledge about their symptoms.