Assessment of urologists' practice preferences for the management of benign prostatic hyperplasia in the Veterans Administration program

Objective: The goal of this study was to assess diagnostic and treatment modality preferences of urologists for the management of benign prostatic hyperplasia (BPH) in the Veterans Administration (VA) patient population. Methods: A self-administered mail survey was sent to 294 urologists who provide services to the VA population in 149 VA medical centers across the United States. The survey contained descriptions of simulated BPH cases, for which the urologists were asked to indicate their preferences in diagnostic tests and treatment options. The survey also gathered information on the frequency of failed initial therapy and demographic and practice information. A nonresponse survey was conducted to estimate nonresponse bias. Results: The response rate was 39.0%. There were no significant differences between nonrespondents and respondents on selected important demographic and practice variables. Respondents generally selected practices that were consistent with clinical guidelines for recommended tests, but their preferences for optional tests varied. Alpha-blockers were the most preferred treatment option, regardless of disease severity. The second most preferred option in mild BPH was watchful waiting, whereas in both the moderate and severe cases it was transurethral resection of the prostate. The respondents reported a treatment failure rate of 41.1%. The most common switch in therapy was from alpha-blockers to surgery. Urologists were in moderate agreement in terms of their preference for diagnostic tests and in substantial agreement on treatment preferences. Conclusions: This study provides insight into the preferences of VA urologists regarding the diagnosis and management of BPH. However, the results need to be validated by assessment of the VA clinical records of actual new patients with BPH.