[Analysis of the clinical decision in the initial management of BPH]

Diagnostic management of prostate benign hyperplasia remains a controversial issue subject to variations as made evident in surveys conducted in our country showing that 47.9% urologists regularly perform intravenous urography. The aim of this paper was to determine the preferred strategy from the standpoint of a more accurate diagnosis for evaluation of patients with prostate benign hyperplasia and no absolute indication for surgery.

The methodology used was an analysis of the decision taken by elucidation of the problem using a decision tree with three major choices: (a) to perform IPSS, flowmetry and ultrasound: (b) to perform IPSS and flowmetry, or (c) to perform IPSS alone. Basic analysis by estimation of the expected value and three sensitivity analysis, one-tailed and two-tailed, were used to see whether the dominant choice changed.

The choice of performing IPSS alone, resulted in accurate diagnosis adjustment in 80.5% cases. When flowmetry was added from the beginning, this percentage declined to 66.2%; if ultrasound was also done, the decline reached down to 11.2%. The Odds Ratio (OR) for diagnosis imbalance was 15.52 and 33, in choice (a) versus choices (b) and (c), respectively. The OR for the IPSS and flowmetry choice to cause imbalance versus IPSS alone was 2, 12. Also, the choice with greater expected value was IPSS, and this result did not change with the sensitivity analysis.

The choice that considers the possibility of symptom quantification in the IPSS scale and, based on the results, continuation of the diagnostic sequence is the one that should be followed, since it provides higher effectiveness from the standpoint of diagnosis adjustment.