Changes in benign prostatic hyperplasia management in Valencia: a real-world evidence analysis.

INTRODUCTION AND OBJECTIVES: A training program was developed to increase general practitioners' engagement in the optimal management of Benign Prostatic Hyperplasia (BPH). The goal of this study was to evaluate changes in BPH management after the implementation of a training program. MATERIAL AND METHODS: This observational retrospective cohort study was conducted between 2019 and 2020. Aggregated data were analyzed in three evaluation periods (2010, 2012 and 2015), addressing quality indicators for diagnosis, treatment, and treatment outcomes. RESULTS: Overall, 118 795 patients who presented any data points were included. All quality indicators (number of IPSS and PSA determinations) increased between the first period and the last. Combination (α-blocker + 5-ARI) therapy was increasingly prescribed during the study periods whereas the proportion of prescriptions for single-agent α-blocker showed no significant differences among the periods analyzed. However, the total number of patients eligible for combination therapy who actually received this treatment was low in all periods (7.5%, 17.9%, and 20.1%, in 2010, 2012, and 2015, respectively). The outcome indicators revealed a decrease in referrals to the urology unit mostly among newly diagnosed patients. Even though the proportion of patients who underwent BPH-related surgeries increased significantly from the first to the second period, the number of surgeries remained stable between the second and third periods. CONCLUSIONS: The training program had a generally positive impact on the management of BPH patients in PC, but the overall study period may be insufficient to show an effect on some outcome indicators such as the number of surgeries.

Documento de consenso sobre pautas de actuación y seguimiento del varón con síntomas del tracto urinario inferior secundarios a hiperplasia prostática benigna / Consensus document on the management and follow-up of the male with lower urinary tract symptoms secondary to benign prostate hyperplasia

La hiperplasia benigna de próstata (HBP) es una patología con una alta incidencia. Su diagnóstico y tratamiento son compartidos entre urólogos y médicos de atención primaria. Su manejo consume una enorme cantidad de recursos. La Sociedad Española de Médicos de Atención Primaria (SEMERGEN), la Sociedad Española de Médicos Generales y de Familia (SEMG), la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) y la Asociación Española de Urología (AEU) han elaborado un documento sobre pautas de actuación y seguimiento de la HBP, presentado aquí de manera resumida, en el que se pretende actualizar las guías anteriormente publicadas, en base a las últimas evidencias. Estas nuevas recomendaciones tienen como objetivo principal sensibilizar al médico de atención primaria y ayudarle en la evaluación diagnóstica, el tratamiento y el seguimiento, además de aportar criterios unificados y consensuados de derivación al segundo nivel asistencial (AU)

Benign prostate hyperplasia (BPH) is a high-incidence condition. Its diagnosis and treatment is shared between urologists and Primary Care physicians. Its management uses up a significant amount of resources. The Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of General Practitioners and Family Doctors (SEMG), the Spanish Society of Family and Community Medicine (semFYC), and the Spanish Association of Urology (AEU) have prepared a document on the management and monitoring of BPH, in which the aim is to incorporate the latest evidence in order to update the previously published guidelines, and present them here in condensed form. The main objective of these new recommendations is to raise the awareness of Primary Care physicians and assist them in its diagnostic evaluation, treatment and monitoring, as well as providing unified consensus criteria for referral to the secondary care level (AU)

[Consensus document on the management and follow-up of the male with lower urinary tract symptoms secondary to benign prostate hyperplasia]. / Documento de consenso sobre pautas de actuación y seguimiento del varón con síntomas del tracto urinario inferior secundarios a hiperplasia prostática benigna.

Benign prostate hyperplasia (BPH) is a high-incidence condition. Its diagnosis and treatment is shared between urologists and Primary Care physicians. Its management uses up a significant amount of resources. The Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of General Practitioners and Family Doctors (SEMG), the Spanish Society of Family and Community Medicine (semFYC), and the Spanish Association of Urology (AEU) have prepared a document on the management and monitoring of BPH, in which the aim is to incorporate the latest evidence in order to update the previously published guidelines, and present them here in condensed form. The main objective of these new recommendations is to raise the awareness of Primary Care physicians and assist them in its diagnostic evaluation, treatment and monitoring, as well as providing unified consensus criteria for referral to the secondary care level.

Disfunción sexual en la hipertensión arterial / Sexual dysfunction and hypertension

La mayoría de las disfunciones sexuales tienen una etiología multifactorial y determinadas enfermedades crónicas causan o están asociadas a disfunciones sexuales con mucha frecuencia, incluso algunos fármacos de uso común en estas enfermedades pueden generar alteraciones sexuales. La hipertensión arterial puede ser causa condicionante y, en ocasiones, determinante de la disfunción sexual en el hombre, siendo la disfunción eréctil una de las patologías más prevalentes y mejor conocidas dentro del capítulo de las disfunciones sexuales. La prevalencia de disfunción eréctil en la población hipertensa puede alcanzar el 50 %, siendo más grave que en la población general. La aparición de la misma está probablemente poco relacionada con el tipo de fármaco empleado para su control y más relacionada con los valores de presión arterial y la coexistencia de otros factores de riesgo cardiovascular. En todo hipertenso se debe evaluar la función sexual en el momento del diagnóstico y tras la introducción de nuevos fármacos, ya que la disfunción eréctil afecta claramente a la calidad de vida y su aparición está asociada a la utilización de un nuevo antihipertensivo compromete la adhesión al tratamiento. La evidencia disponible indica que los diuréticos, betabloqueantes, antiadrenérgicos de acción central y vasodilatadores son los fármacos más relacionados con la disfunción eréctil y que los antagonistas de los receptores de la angiotensina y la doxazosina pueden mejorar la función sexual en pacientes hipertensos

Sexual dysfunction (SD) is understood as a persistent or recurrent alteration in any phase of the human sexual response cycle, and which consequently renders it inadequate. Most SD's have a multifactorial ethiology, and certain chronic diseases cause or are often associated with SD. Even certain drugs commonly used in the treatment of such diseases can provoke sexual alterations. Hypertension can be a cause which conditions and sometimes determines male SD, with erectile dysfunction (ED) being one of the most prevalent and well- known pathologies within the scope of SD. The prevalence of ED in the hypertensive population may be as high as 50 %, it being more severe than in the general population. Its presence is probably less related to types of drugs used than to blood pressure values and coexistence of other cardiovascular risk factors. In all hypertensive men, sexual function should be evaluated both at time of diagnosis and after the introduction of new drugs since ED clearly affects quality of life, and its appearing in association with the introduction of a new antihypertensive drug may jeopardize adherence to treatment. Available evidence indicates that diuretics, betablockers, antiadrenergics of central action (methyldopa and clonidine) and vasodilators are those drugs more related to ED, and that both angiotensin receptor blockers and doxazosin can improve sexual function in hypertensive patients. In those controlled patients under treatment, but with ED, symptomatic treatment with 5-phosphodiesterase inhibitors must be evaluated