Diagnosis and treatment of prostatitis in Canada
Diagnosis and treatment of prostatitis in Canada
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DOI：
10.1016/s0090-4295(98)00297-0
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发表时间：
1998-11-01
期刊：
影响因子：
2.1
通讯作者：
Hosking, D
中科院分区：
文献类型：
--
作者：
Nickel, JC;Nigro, M;Hosking, D
目标.医生们有一个普遍的共识：目前慢性前列腺炎的治疗是令人沮丧的。我们对加拿大初级保健医生（PCP）和泌尿科医生进行了一项调查，以确定挫折的程度和来源，并分析目前这种疾病的实践模式。5000名PCP和所有545名加拿大泌尿科医生被要求完成一项全面的计算机辅助电话调查，探讨前列腺炎管理的实践特征，态度，诊断和治疗策略。属性库的随机化，遵守问卷调查路线，现场监测的验证，以及可能的偏见。从10%的PCP和28%的泌尿科医生中获得了完整的访谈。PCP平均每月看到3.5（中位数2）例前列腺炎患者，泌尿科医生平均每月看到21.8（中位数11）例前列腺炎患者。所有的医生在治疗前列腺炎时都比治疗良性前列腺增生（BPH）和前列腺癌患者时经历更多的挫折，他们认为前列腺炎对患者生活质量的影响明显大于BPH，几乎与前列腺癌一样多。在处理前列腺炎的挫折和不快的程度是由缺乏信心和舒适的能力，以准确诊断和随后合理化治疗驱动。大多数PCP和泌尿科医生继续采用除病史和体格检查以外的步骤来确定诊断，但只有少数PCP和三分之一的泌尿科医生使用特定的下尿路培养。医生倾向于使用甲氧苄啶或甲氧苄啶-磺胺甲恶唑（TMP-SMX）或氟喹诺酮作为慢性前列腺炎的常规一线治疗。慢性前列腺炎最常用的治疗策略（40%）是TMP-SMX作为一线治疗，氟喹诺酮作为二线治疗。结论。对于PCP和泌尿科医生治疗前列腺炎的能力，普遍存在挫折感、不适感和缺乏信心。医生们表示希望更好地了解这种疾病，更简单，更清晰的诊断指南，更合理的治疗策略。(C)1998年，Elsevier Science Inc. All rights reserved.
Objectives. There is a general consensus among physicians: that the present management of chronic prostatitis is dismal. We undertook a survey of Canadian primary care physicians (PCPs) and urologists to determine the degree and source of frustration and to analyze present practice patterns in this disease.Methods. Five thousand PCPs and all 545 Canadian urologists were asked to complete a comprehensive computer-assisted telephone survey that explored practice characteristics, attitudes, and diagnostic and treatment strategies in the management of prostatitis. Randomization of attribute banks, adherence to questionnaire routing, validation by on-site monitoring, and possible bias were addressed.Results. Completed interviews were obtained from 10% of PCPs and 28% of urologists. PCPs see on average 3.5 (median 2) patients with prostatitis per month and urologists see on average 21.8 (median 11) patients with prostatitis per month. All physicians experience significantly more frustration in treating prostatitis than they do in treating patients with benign prostatic hyperplasia (BPH) and prostate cancer, and they perceive that prostatitis affects patients' quality of life significantly more than BPH and almost as much as prostate cancer. The degree of frustration and unhappiness in dealing with prostatitis is driven by a lack of confidence and comfort in their ability to accurately diagnose and subsequently rationalize treatment. Most PCPs and urologists continue to employ steps in addition to history and physical examination to establish a diagnosis but only a few PCPs and a third of urologists use specific lower urinary tract cultures. Physicians tend to use trimethoprim or trimethoprim-sulfamethoxazole (TMP-SMX) or a fluoroquinolone as their usual first line therapy for chronic prostatitis. The most commonly used therapeutic strategy (40%) for chronic prostatitis was TMP-SMX as first line therapy and a fluoroquinolone as second line therapy.Conclusions. There is widespread frustration, discomfort, and lack of confidence in both PCPs' and urologists' perceived ability to manage prostatitis. Physicians have expressed a desire for a better understanding of this disease, simpler and clearer diagnostic guidelines, and more rational treatment strategies. (C) 1998, Elsevier Science Inc. All rights reserved.