BALTIMORE-IVPs and renal sonograms are fading from the benign prostatic hyperplasia picture.
A 1997 Gallup survey commissioned by the American Urological Association suggests that only 9% of its members are still doing the two imaging tests for BPH three years after guidelines labeled them generally useless. A 1994 Gallup Poll had found 18% of urologists still ordering the exams for BPH.
The guidelines, issued jointly by the Agency for Health Care Policy Research and the AUA, said the tests are indicated only when a patient has other urinary-tract disease or abnormalities, renal insufficiency, previous urinary-tract surgery, or a history of stones.
Dr. H. Logan Holtgrewe of Johns Hopkins, who presented the new survey at an AHCPR meeting on outcomes research, credits the guidelines for reducing the tests, which he himself once ordered routinely for uncomplicated BPH. “There was no justification, but that’s how I was trained,” says Dr. Holtgrewe, once an AUA president. “We were literally wasting money.”
The guidelines recommend that initial BPH evaluation include a detailed medical history, a physical with digital rectal exam and focused neurologic exam, dipstick testing of urine or microscopic examination of urine sediment, and measurement of serum creatinine. The guidelines also list five optional tests if the diagnosis remains unclear.
Dr. Mark Immergut, a Bethesda urologist, says managed-care pressure probably has more to do with urologists dropping the tests than guidelines. But Dr. Joseph Segura of Mayo, who is chairman of AUA’s committee on practice parameters, says 99% of the 1,200 urologists polled said they knew about the guidelines. -Cori Vanchieri
BALTIMORE-IVPs and renal sonograms are fading from the benign prostatic hyperplasia picture.
