Proposed Korean guideline for the diagnosis of BPH Hyun Woo Kim The Catholic University of Korea
BPH Guideline AHCPR guideline on BPH (1994) AUA guideline on BPH (2003) EAU guideline on BPH (2004) International Consultation on New Development in Prostate Cancer and Prostate Disease (ICUD, 2005)
BPH Guideline Recommend : AUA, EAU History Taking DRE Symptom Assessment : IPSS PSA Urine analysis Uroflowmetry PVR measurement Serum Cr Voiding diary Urine cytology Pressure flow study Urethrocytoscopy Upper tract USG TRUS Filling CMG IVP RGP, CT, MRI
Characteristics of prostate in Koreans Korean men have a lower PSA and a smaller PV than Caucasians. JS Cho et al. Korean J Urol, 2005 Korean men demonstrated more clinical symtoms and a higher ratio of transition zone index. J Choi et al. European Urology, 2002
Korean men - higher prevalence of LUTS despite smaller prostates. (more clinical symptoms) - higher ratio of transition zone index.
Korean men - a lower PSA a smaller PV than Caucasians. - The PV of Korean men corresponding to a PV of 40mL for Caucasians is approximately 35mL
AUA Guideline 2003
Changes of diagnostic AUA 2003 guideline of BPH Serum PSA : recommended in selected patients Urine cytology : option in man with predominantly irritative symptoms Other validated symptom assessment instruments are supplementary Serum creatinine : no longer recommended on initial evaluation Discussion of treatment options before PFS
Optional Diagnostic Tests Uroflowmetry and PVR measurement - Not necessary prior to the watchful waiting, medical therapy - May be helpful complex medical history neurologic disease, disease known to affect bladder fn. prior failure of BPH therapy desiring invasive therapy
Additional Optional Diagnostic Tests 1 PFS 2 Urethrocystoscopy 3 US (transrectal or transabdominal) Optional in patients choosing invasive therapies. Not recommended in the initial evaluation of LUTS
Korean BPH guideline 2006 대한배뇨장애요실금학회-전립선학회 공동심포지엄 - Evaluation and Treatment Guideline of LUTS/BPH Evaluation guideline 동국대 이경섭 2007 The Prostate day 심포지엄 - Suggested Korean BPH Guideline Evaluation Guideline 가톨릭의대 이지열 2007 대한전립선학회-배뇨장애요실금학회 공동심포지엄 How to Shape-up LUTS/BPH Guideline in Korea? 포천중문의대 박동수
2006 대한배뇨장애요실금학회-전립선학회 공동심포지엄 - 동국대 이경섭
2006 대한배뇨장애요실금학회-전립선학회 공동심포지엄 - 동국대 이경섭
2007 The Prostate day 심포지엄 - 가톨릭의대 이지열
2007 The Prostate day 심포지엄 - 가톨릭의대 이지열
2007 대한전립선학회-배뇨장애요실금학회 공동심포지엄 포천중문의대 박동수
Mailed to random sample of 850 members in June, 2004 (the Korean urological Association Registry of Physicians) 277 (final analysis, 32.6%) 162(58.5%) : private clinics 46 (16.6%) : general hospitals 69 (24.9%) : university hospitals
Initial assessments 1. Urinalysis (90.3%) 2. DRE (86.6%) 3. PSA (62.5%) 4. Symptom assessment (46.9%) 5. TRUS (45.5%) 6. Uroflowmetry (34.7%) 7. PVR measurement (33.6%)
Before surgery 1. Urinalysis (95.8%) 2. DRE (94.4%) 3. PSA (94.4%) 4. TRUS (83.8%) 5. Uroflowmetry (81.7%) 6. Symptom assessment (78.9%) 7. Creatinine (78.9) 8. PVR measurement (76.8%)
The purpose of clinical practice guidelines reduce unwanted variation in practice improve patient care by setting standards based on the best available evidence. The diagnostic and treatment practices for BPH do not follow published guideline. How influential are international guideline, and do they really affect patient management in countries that do not have country-specific guidelines?
Practice patterns in the medical treatment of BPH in the Korea; Nationwide survey on 2007 Byung Ha Chung
Routine test and examination for diagnosis of BPH For the initial evaluation of BPH, most urologists routinely performed PSA, DRE and TRUS
Routine test and examination for diagnosis of BPH 2004 ( JS Paick et al) 62.5% 86.6% 46.9% 45.5% 33.6% 34.7%
Summery Recommended tests (should be done on every patient) 1History 2 Assessment of symptoms and bother (IPSS) 3 Physical examination inclusive of DRE 4Urinalysis 5 Serum prostate-specific antigen (PSA) 6 TRUS ( in Korean insurance system) 7 UFM and PVR 국내의 실정에 맞는 학회차원에서의 진료지침의 작성 회원교육을 통한 실제 임상에서 진료지침의 적용