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Chinese Urologists' Practice Patterns Of Diagnosing And Treating Chronic Prostatitis: A Questionnaire Survey

September 02, 2017

UroToday - Chronic prostatitis (CP) is one of the most prevalent conditions in urology, and represents an important international health problem. Throughout the past century, the diagnostic entity of CP has been recognized and its clinical characteristics well described. However, despite the multiple approaches to management of CP, no hard and fast guidelines have been developed. To date, several surveys of urologists have been undertaken in order to examine their attitudes, diagnostics and treatment modalities applied in patients with CP. Yet Chinese circumstances surrounding CP have not been clarified. In order to define the current spectrum of practice of Chinese urologists, we initiated a comprehensive cross-sectional study to determine the current situation among Chinese urologists with regard to diagnosis and treatment of patients with CP.

We conducted this survey during the period of the 13th China National Urology Academic Conference and the 8th Global Chinese Urology Academic Conference (CUA 2006), which was held in Shenyang, Liaoning Province on October 13-15, 2006. A sample of 656 Chinese urologists attending the CUA 2006 meeting was surveyed using a questionnaire that explored attitudes and diagnostic and treatment patterns in the management of CP.

The results provide a picture of current practices regarding the management of CP in China and some interesting findings were demonstrated in our study. More than one-third of urologists were not familiar with the new classification proposed in 1995 in the USA by the NIH (National Institutes of Heath) designed to remove this disease from the strict context of the prostate, placing greater emphasis on the concept of pain and introducing the concept of male chronic pelvic pain syndrome. A minority of urologists performed the Meares-Stamey 4-glass test, also known as a quantitative prostatic localization study. Although most Chinese urologists considered CP to be non-bacterial in nature, many (74.0%) still chose antibiotics as the first choice of therapy. Most urologists said they would prescribe antibiotics when bacterial culture was positive (64.4%) or excessive leukocytes and/or pyocytes were present in EPS (65.9%). The second most commonly used pharmaceutical therapy was alpha-blockers (60.3%). Interestingly, most urologists (70.3%) use alpha-blockers just to relieve obstructive voiding symptoms. The most commonly used non-pharmacological therapy was psychotherapy (60.7%) and prostatic massage (54.2%). The beliefs regarding the etiology affect the diagnostic and treatment strategies; meanwhile, the diagnostic practice has an influence on the selection of treatment methods. Our findings also suggest that the personal beliefs or attitudes towards CP, and the practice characteristics of individual urologists might have an influence on the patterns of routine treatments for cases of CP.1

This is the first nationwide survey of clinical practice patterns for CP among urologists in China. Wide variations in physicians' understanding and clinical practice are demonstrated in this study. As seen in other countries, there is much confusion and frustration experienced by Chinese urologists in the management of CP. This reflects the inability to identify the cause of voiding symptoms in many of patients with CP and has likely led to the varied therapies that are used. It is necessary to improve their cognitive level about CP and standardize their practice patterns. Moreover, many hypotheses of etiology and mechanisms of pathogenesis of CP have been proposed and a wide scope of evaluations for diagnosis and treatment methods for CP have been recommended. In this situation, the view of "evidence-based" medicine is very important in clinical practice of CP.

Admittedly, this study has some limitations. Firstly, the physicians' responses are self-reported behaviors and their answers may reflect more idealized versions of what actually takes place. Thus, the findings must be interpreted with caution. Secondly, the study population was not drawn from random samples, so the representative is affected. However, with a relatively high valid response number (more than 500) and data from almost all administrative regions of China, the demonstrated data are deemed representative in reflecting the current management of CP in China.

1 Liu LF, Yang JR, Ginsberg DA, Xie HW, Rao JM, Wang L, Yin Z, He Q and Yang TB: Factors influencing the diagnosis and treatment of chronic prostatitis among urologists in China. Asian J Androl. 10: 675-681, 2008.

Longfei Liu, MD, Jinrui Yang , MD, Huiwen Xie, MD and , David A. Ginsberg, MD, as part of Beyond the Abstract on UroToday.

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