Benign prostatic hyperplasia evaluation, treatment and association with sexual dysfunction: practice patterns according to physician specialty


  • DisclosuresA. D. Seftel: consultant to Lilly, Pfizer, Auxilium, Indevus, sanofi-aventis and Solvay. R. C. Rosen: consultant to sanofi-aventis. M.T. Rosenberg: consultant to Astellas, GSK, Novartis, sanofi-aventis, Ortho-McNeil, Pfizer and Verathon; speaker for Astella, GSK, Ortho-McNeil and Verathon; research funding from sanofi-aventis and Ortho-McNeil. R. Sadovsky: none. [Correction added after the online publication, 21st February 2008, where the following statement was omitted from the Disclosure section] As Urology Section Editor for the Journal, Matt T. Rosenberg withdrew from the review process and deferred all editorial decisions to Graham Jackson.

Allen D. Seftel, MD,
Case Medical Center/University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-5046, USA
Tel.: + 1 216 844 7728
Fax: + 1 216 844 1900


Aims:  Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) are a common problem in ageing men and are accompanied by sexual dysfunction (SD) in 40–70% of men evaluated in large-scale epidemiological studies. One year after the 2003 American Urological Association (AUA) guideline on BPH management was published, a survey of US urologists (UROs) and primary care physicians (PCPs) was conducted to ascertain physician knowledge of the AUA guideline and practice patterns regarding LUTS/BPH diagnosis, treatment and association with SD.

Methods:  A 19-question qualitative survey, sponsored by the American Foundation of Urologic Disease, was mailed April 2004 to 7500 UROs and 17,500 PCPs, with responses collected until May 2004.

Results:  A total of 788 surveys were returned (437 UROs; 351 PCPs). Only 62% of PCPs were aware of and only 41% of PCPs used the AUA-Symptom Index/International Prostate Symptom Score (AUA-SI/IPSS) to assess LUTS compared with 97% and 81% of UROs respectively. Alpha-blocker monotherapy was the treatment of choice for both UROs and PCPs. Compared with UROs, PCPs reported higher rates of SD in association with LUTS or BPH (37% vs. 27%) and BPH pharmacotherapy (27% vs. 21%). UROs and PCPs reported higher rates of SD side effects [ejaculatory dysfunction (EjD) and erectile dysfunction (ED)] for tamsulosin (EjD: UROs 22%, PCPs 12%; ED: UROs 7%, PCPs 10%) and doxazosin (EjD: UROs 14%, PCPs 10%; ED: UROs 7%, PCPs 12%) than for alfuzosin (EjD: UROs 6%, PCPs 4%; ED: UROs 4%, PCPs 5%).

Conclusions:  The results suggest that many PCPs are not using the AUA-SI/IPSS to assess LUTS in their ageing male patients. Both UROs and PCPs appear to be underestimating the prevalence of SD in men with LUTS/BPH relative to prevalence rates reported in large-scale epidemiological studies.