Criterios de derivación en hiperplasia benigna de próstata para atención primaria / Referral criteria for benign prostatic hyperplasia in primary care

La hiperplasia benigna de próstata (HPB) es una enfermedad con alta prevalencia entre los varones de más de 50 años que requiere una continuidad asistencial entre los 2 niveles existentes en nuestro país, el de atención primaria (AP) y el de atención especializada; motivo por el que era necesario consensuar unos criterios de derivación o de continuidad que sirvan de orientación a ambos colectivos. La historia clínica del paciente, el Índice Internacional de Síntomas Prostáticos (IPSS, International Prostate Symptom Score), el tacto rectal y el antígeno prostático específico (PSA, prostate-specific antigen) son herramientas accesibles en el ámbito de la AP que permiten un diagnóstico adecuado de la HBP. Conscientes de tal necesidad, las sociedades científicas de atención primaria (Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Medicina General [SEMG] y Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) y la Asociación Española de Urología (AEU) elaboraron este documento de consenso. A los pacientes con IPSS<8 se los deberá mantener en vigilancia y evaluar anualmente; en los pacientes con IPSS 8-20, si el tamaño de la próstata es pequeño, se recomienda el tratamiento con bloqueadores alfa y evaluación al primer y tercer mes, si el tamaño de la próstata es grande se recomienda el tratamiento con bloqueadores alfa o inhibidores de la 5-alfa-reductasa y evaluación al tercery sexto mes, y en el caso de pacientes con próstata grande y PSA 41,5 ng/ml se recomienda el tratamiento combinado y la evaluación al primer y sexto mes. En este documento se establecen unos criterios de derivación al urólogo claros, que facilitan el tratamiento de este tipo de pacientes. Se derivarán al urólogo aquellos pacientes con HBP que no presenten mejoría al tercer mes de tratamiento con bloqueadores alfa, o al sexto mes de tratamiento con inhibidores de la 5-alfa-reductasa(AU)

Se derivarán también los pacientes con síntomas del tracto urinario inferior en los que se observe algún hallazgo patológico durante el tacto rectal, IPSS >20, PSA >10 ng/ml o PSA >4 ng/ml y PSA libre <20% o pacientes con edades < 50 años y sospecha de HBP, así como aquellos pacientes con alguna complicación urológica(AU)

Benign prostatic hyperplasia (BPH) is a high prevalence condition in men over 50 years that requires continued assistance between primary care and urology. Therefore, consensus around common referral criteria was needed to guide and support both levels. Medical history, symptom assessment with International Prostate Symptom Score (IPSS) questionnaire, digital rectal examination and prostate-specific antigen (PSA) measurement are diagnostic tests available for general practitioners that allow setting a correct BPH diagnose. Patients with an IPSS<8 should be monitored by evaluating them annually. Treatment with α-blockers and an evaluation at the first and third month is recommended in patients with an IPSS 8-20 and if the prostate is small, if the prostate size is large treatment with α-blockers or 5α-reductase inhibitors and evaluation at the third and six month is recommended, and in patients with a large prostate and a PSA >1.5ng/ml combined treatment and evaluation at the first and sixth month is recommended. Some clear criteria for referral to urology are established in this document, which help in the management of these patients. Those patients with BPH who do not show any improvement at the third month of treatment with α-blockers, or the sixth month with 5α-reductase inhibitors, will be referred to urology. Patients will also be referred to urology if they have lower urinary tract symptoms, a pathological finding during rectal examination, IPSS>20, PSA>10ng/ml or PSA>4ng/ml and free PSA<20% or if they are <50 years with suspected BHP, or if they have any urological complication(AU)

[Referral criteria for benign prostatic hyperplasia in primary care]. / Criterios de derivación en hiperplasia benigna de próstata para atención primaria.

Benign prostatic hyperplasia (BPH) is a high prevalence condition in men over 50 years that requires continued assistance between primary care and urology. Therefore, consensus around common referral criteria was needed to guide and support both levels. Medical history, symptom assessment with International Prostate Symptom Score (IPSS) questionnaire, digital rectal examination and prostate-specific antigen (PSA) measurement are diagnostic tests available for general practitioners that allow setting a correct BPH diagnose. Patients with an IPSS<8 should be monitored by evaluating them annually. Treatment with alpha-blockers and an evaluation at the first and third month is recommended in patients with an IPSS 8-20 and if the prostate is small, if the prostate size is large treatment with alpha-blockers or 5alpha-reductase inhibitors and evaluation at the third and six month is recommended, and in patients with a large prostate and a PSA >1.5 ng/ml combined treatment and evaluation at the first and sixth month is recommended. Some clear criteria for referral to urology are established in this document, which help in the management of these patients. Those patients with BPH who do not show any improvement at the third month of treatment with alpha-blockers, or the sixth month with 5alpha-reductase inhibitors, will be referred to urology. Patients will also be referred to urology if they have lower urinary tract symptoms, a pathological finding during rectal examination, IPSS>20, PSA>10 ng/ml or PSA>4 ng/ml and free PSA<20% or if they are <50 years with suspected BHP, or if they have any urological complication.

[Diagnosis and management of patients with overactive bladder syndrome in urology clinics and general practitioner clinics in Spain]. / Diagnóstico y manejo de pacientes con síndrome de vejiga hiperactiva en las consultas de urología y atención primaria en España.

OBJECTIVES: Despite its high prevalence and its important impact on patient's life, overactive bladder is a disorder poorly known and not usually tackled in daily clinical practice. The aim of this study is to know the main procedures and techniques used by both urologists and general practitioners to diagnose overactive bladder in usual clinical practice in Spain. METHODS: A standardized questionnaire was administered to 748 physicians specialized in urology and to 696 primary core physicians or general practitioners. The questionnaire collected information about the management of patients who attended surgery with urinary symptoms suggesting overactive bladder. RESULTS: A total of 64.8% of urologists argued they followed a standardized protocol in order to diagnose patients suffering from overactive bladder. Concerning primary care physicians, 58.4% of them admitted not referring patients with urinary symptoms suggesting overactive bladder to specialist. Up to 77.8% of urologists confirmed that referred patients from primary care had no previous exam or diagnosis. Health history, physical examination and urinalysis were the usual diagnosis procedures in clinical practice conditions for both specialities. Other instruments such as the micturition diary or the questionnaires to assess symptoms or patients' quality of life are still little used for the diagnosis and management of overactive bladder. CONCLUSIONS: Although overactive bladder is a condition that causes a high impairment in the quality of life (QoL) and daily activities of those patients suffering from it, it still remains poorly tackled by doctors. Therefore, it is important to define strategies to detect its symptoms in the clinical practice.

Diagnóstico y manejo de pacientes con síndrome de vejiga hiperactiva en las consultas de urología y atención primaria en España / Diagnosis and management of patients with overactive bladder syndrome in urology clinics and general practitioner clinics in Spain

OBJETIVOS: El Síndrome de Vejiga Hiperactiva (SVH), a pesar de presentar una elevada prevalencia y un impacto importante en la vida del paciente, es un trastorno mal conocido y poco abordado en la práctica asistencial. El objetivo del estudio es conocer las diferentes técnicas y procedimientos empleados en el diagnóstico de SVH, tanto por urólogos como por médicos de atención primaria (AP), en condiciones de práctica clínica habitual en España. METODOS: Se administró un cuestionario estandarizado a 748 médicos especialistas en urología y 696 médicos de AP. Dicho cuestionario recogía información sobre el manejo de los pacientes que acudían a su consulta con síntomas urinarios sugestivos de SVH. RESULTADOS: Un 64,8% de los urólogos afirmaron seguir algún protocolo estandarizado para el diagnóstico de pacientes con SVH. Un 58,4% de los médicos de AP afirmaron no derivar a los pacientes con síntomas urinarios sugestivos de SVH. Un 77,8% de los urólogos afirmaron que los pacientes que venían derivados desde AP llegaban sin ningún diagnóstico ni estudio previo. En ambas especialidades la historia clínica, la exploración física y el análisis de orina son procedimientos que forman parte de la práctica diagnóstica habitual. Otras medidas como son el diario miccional y los cuestionarios de síntomas o de evaluación de la calidad de vida son aún poco utilizados en el diagnóstico y manejo del SVH. CONCLUSIONES: Si bien el SVH es una condición que conlleva una gran afectación de la Calidad de Vida (CdV) y de las actividades diarias de los pacientes que lo padecen, todavía está poco abordada desde el punto de vista asistencial. Es importante establecer estrategias de detección de los síntomas en la práctica clínica (AU)

OBJECTIVES: Despite its high prevalence and its important impact on patient's life, overactive bladder is a disorder poorly known and not usually tackled in daily clinical practice. The aim of this study is to know the main procedures and techniques used by both urologists and general practitioners to diagnose overactive bladder in usual clinical practice in Spain. METHODS: A standardized questionnaire was administered to 748 physicians specialized in urology and to 696 primary core physicians or general practitioners. The questionnaire collected information about the management of patients who attended surgery with urinary symptoms suggesting overactive bladder. RESULTS: A total of 64.8% of urologists argued they followed a standardized protocol in order to diagnose patients suffering from overactive bladder. Concerning primary care physicians, 58.4% of them admitted not referring patients with urinary symptoms suggesting overactive bladder to specialist. Up to 77.8% of urologists confirmed that referred patients from primary care had no previous exam or diagnosis. Health history, physical examination and urinalysis were the usual diagnosis procedures in clinical practice conditions for both specialities. Other instruments such as the micturition diary or the questionnaires to assess symptoms or patients' quality of life are still little used for the diagnosis and management of overactive bladder. CONCLUSIONS: Although overactive bladder is a condition that causes a high impairment in the quality of life (QoL) and daily activities of those patients suffering from it, it still remains poorly tackled by doctors. Therefore, it is important to define strategies to detect its symptoms in the clinical practice