[Clinical practice guidelines (CPG): are they useful? Example of the benign prostatic hyperplasia (BPH)]

Clinicians develop routine strategies with multiple and sometimes hardly relevant origins. The logical theoretical solution would be to make available systematically drafted clinical practice guidelines (CPG) with the aim of helping the physician during daily practice. These CPG summarize the best available proofs and relate each recommendation to a level of proof. However, if the CPG is not rigorously drafted, their usefulness is questionable. The AGREE scale, translated into several languages and used by several european countries, including France (ANAES), is useful for the evaluation of the quality of drafting of a CPG but also as a guide when making a CPG. The analysis of different CPG for the management of benign prostatic hyperplasia (HBP) originating from different countries and companies shows important variations which are best explained by large differences in the rigour of drafting. Besides, whatever the quality of the CPG, they too often neglect the key element which is its application in practice. A survey of the modalities of prescription of subsequent examinations in France in HBP demonstrates an important disparity between CPG and routine attitudes in clinical practice. A potential solution may require a deeper involvement of the learned urologic society in the drafting and distribution of the CPG.